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Heart Health - Cardiac Rehabilitation

Wed, 01 Apr 2026 06:19:33 GMT

Why cardiac rehabilitation is critical after a cardiac event.

If you've recently had coronary artery bypass surgery —or are preparing for one—you've likely heard about cardiac rehabilitation. But you might be wondering: Is it really for me? The short answer is yes. Research consistently shows that cardiac rehabilitation benefits virtually everyone who has had bypass surgery, regardless of age, sex, or other health conditions. In fact, the patients who might think they're "too old" or "too sick" for rehabilitation are often the ones who benefit the most.

What Is Cardiac Rehabilitation?

Cardiac rehabilitation is a medically supervised program designed to help you recover after heart surgery and reduce your risk of future heart problems. It's not just exercise—it's a comprehensive approach that includes:

Supervised exercise training tailored to your fitness level
Education about heart disease, medications, and warning signs
Nutritional counselling for heart-healthy eating
Psychological support for anxiety, depression, and stress management
Help with lifestyle changes like quitting smoking and managing weight

Programs typically run for 12 weeks, with sessions two to three times per week. You'll work with a team of specialists including doctors, nurses, exercise physiologists, and dietitians who create a personalised plan just for you.

Who Gets Referred to Cardiac Rehabilitation?

Cardiac rehabilitation is recommended for all patients after bypass surgery—this is the highest level of recommendation from major heart associations worldwide. You're a candidate for cardiac rehabilitation if you've had:

Coronary artery bypass graft surgery (CABG)
A heart attack (myocardial infarction)
Angioplasty or stent placement (PCI)
Heart valve surgery
Heart transplant
Stable angina (chest pain)
Heart failure with reduced pumping function

Common characteristics of patients referred to cardiac rehabilitation include:

History of coronary artery disease or heart attack
Recent heart surgery or procedure
Risk factors such as high blood pressure, high cholesterol, diabetes, or smoking history
Reduced exercise capacity or shortness of breath with activity
Need for lifestyle modification and risk factor management

The goal is to help you regain strength, improve your heart health, and reduce your

chances of future heart problems—regardless of your starting point.

Which Groups Are at Higher Risk Without Cardiac Rehabilitation?

While everyone benefits from cardiac rehabilitation, certain groups face significantly higher risks if they don't participate. Ironically, these are often the same groups least likely to attend.

1. Older Adults (65 and Over)

If you're over 65, you might think cardiac rehabilitation isn't for you—but the opposite is true. Older adults face higher rates of complications after bypass surgery, including longer recovery times, increased risk of hospital readmission, and greater likelihood of functional decline. Research shows that cardiac rehabilitation improves cardiovascular risk factors and reduces the risk of recurrent heart problems and death in older adults, with benefits similar to younger patients.

Unfortunately, only about 25% of eligible older patients participate in cardiac rehabilitation.

Don't let age be a barrier—older adults who participate show significant improvements in

strength, endurance, and quality of life.

2. Women

Women derive the same survival and quality-of-life benefits from cardiac rehabilitation as men, yet they participate less often across all age groups. Women may face unique barriers including caregiving responsibilities, transportation challenges, and programs that haven't traditionally been designed with women's needs in mind. If you're a woman who has had bypass surgery, cardiac rehabilitation is just as important for you as for anyone else.

3. People With Diabetes

If you have diabetes, cardiac rehabilitation is particularly important. Studies show that people with diabetes who participate in cardiac rehabilitation have a 44% reduction in death from any cause and a 23% reduction in the combined risk of death, heart attack, or need for another procedure. Diabetes increases your risk of heart disease progression, making the lifestyle changes and monitoring provided in cardiac rehabilitation especially valuable.

4. People With Multiple Health Conditions

Having other health problems—such as kidney disease, lung disease, or peripheral artery disease—doesn't mean you shouldn't do cardiac rehabilitation. In fact, research shows that patients with multiple health conditions derive similar or even greater relative benefit compared to healthier patients. These conditions increase your baseline risk, which means you have more to gain from participating.

5. People With Heart Failure or Reduced Heart Function

If your heart's pumping ability has been affected (reduced ejection fraction), cardiac rehabilitation is strongly recommended. Participation improves exercise capacity, helps manage symptoms, and may reduce your risk of death. The supervised environment ensures your exercise is safe and appropriately tailored to your heart function.

6. People From Underserved Communities

Patients from lower socioeconomic backgrounds, racial and ethnic minority groups, and those living in rural areas participate in cardiac rehabilitation at lower rates—yet they often have higher baseline cardiovascular risk. Participation in cardiac rehabilitation for Aboriginal and Torres Strait Islander people is low, generally estimated between 3% and 30% , with recent data showing 50% of referred patients in Queensland initiated a program and 14% of the total cohort completed it. Despite high cardiovascular disease rates, barriers include low referral rates, lack of cultural safety, and distance. If you face barriers to participation, talk to your healthcare team about options like home-based cardiac rehabilitation programs.

Who May Need to Wait or Be Excluded From Cardiac Rehabilitation?

While cardiac rehabilitation is recommended for nearly all patients after bypass surgery, there are some situations where participation may need to be delayed or modified. These exclusions are typically temporary—once the underlying condition is treated or stabilised, most patients can safely begin rehabilitation.

Temporary Medical Exclusions

Certain acute or unstable conditions require treatment before starting cardiac rehabilitation. According to the American Heart Association, these include:

Very recent heart attack (within 2 days)—you'll need a brief period of stabilisation first
Unstable angina—chest pain that is new, worsening, or occurring at rest needs to be controlled before starting exercise
Decompensated heart failure—if your heart failure symptoms have recently worsened significantly, you'll need to be stabilised first
Uncontrolled heart rhythm problems—arrhythmias that affect your heart's ability to pump blood effectively need treatment first
Active blood clots—acute pulmonary embolism or deep vein thrombosis requires treatment before exercise
Active heart inflammation—myocarditis (inflammation of the heart muscle) or pericarditis (inflammation of the heart lining) needs to resolve
Acute aortic dissection—a tear in the main artery requires immediate treatment
Active infection—including endocarditis (infection of the heart valves)

Conditions Requiring Special Consideration

Some conditions don't prevent participation but require careful evaluation and possibly modified programs:

Severe aortic stenosis (narrowing of the aortic valve) with symptoms—may need valve treatment first
Severe heart failure (NYHA Class IV)—patients with the most severe symptoms at rest are typically excluded from standard programs until stabilised
Uncontrolled diabetes or high blood pressure—these need to be better controlled before starting, but don't prevent eventual participation
Significant ischemia at very low exercise levels—if your heart shows signs of inadequate blood flow with minimal exertion (less than 2 METs), you may need further treatment first
Hypertrophic obstructive cardiomyopathy—a condition where the heart muscle is abnormally thick may require modified, lower-intensity programs
Physical disability that prevents safe exercise—though many programs can adapt to various physical limitations

Important Points About Exclusions

Most exclusions are temporary. Once your condition is treated or stabilised, you can typically begin cardiac rehabilitation.
Exclusion from standard programs doesn't mean exclusion from all rehabilitation. Many patients with relative contraindications can participate in modified programs with closer supervision or lower-intensity exercise.
Your healthcare team will assess your individual situation. Don't assume you can't participate—ask your doctor specifically about cardiac rehabilitation and what needs to happen for you to safely begin.
Home-based programs may be an option. If you can't attend centre-based rehabilitation due to medical or practical reasons, home-based programs with remote monitoring may be available.

Non-Medical Barriers

Beyond medical exclusions, some patients face practical barriers that prevent participation. These can include a lack of nearby cardiac rehabilitation programs, transportation difficulties, financial barriers or lack of insurance coverage, and competing time demands (work, caregiving). If you face any of these barriers, speak with your healthcare team. Solutions may include home-based programs, financial assistance, or help with transportation.

How Cardiac Rehabilitation Supports Your Mental Health

One of the most important—but often overlooked—benefits of cardiac rehabilitation is its impact on your emotional wellbeing. Heart surgery is not just a physical challenge; it's an emotional one too.

The Mental Health Challenge After Heart Surgery

Depression and anxiety are extremely common after heart surgery. Research shows that approximately 38% of women and 30% of men experience depression after a heart event—rates much higher than in the general population. These feelings are a normal response to a life-changing event, but they matter for your recovery because:

Depression is associated with higher risk of hospital readmission
Anxiety can prevent you from engaging in healthy behaviours
Psychological distress can interfere with medication adherence
Untreated depression is linked to worse cardiovascular outcomes

How Cardiac Rehabilitation Helps

Cardiac rehabilitation addresses mental health through multiple pathways:

1. Exercise as Medicine for the Mind

Exercise itself is a powerful treatment for depression and anxiety. Research shows that supervised group aerobic exercise is as effective as antidepressant medication in reducing depressive symptoms in patients with heart disease. In one study, patients with depression who adhered to regular physical exercise after a heart attack had 38% to 52% lower rates of death or recurrent heart attack over four years compared to those who didn't exercise regularly.

2. Structured Psychological Support

Modern cardiac rehabilitation programs include psychological assessment and intervention as a core component. This may include:

Screening for depression and anxiety using validated questionnaires
Stress management training
Relaxation techniques
Coping skills development
Referral to mental health specialists when needed

3. Cognitive Behavioural Therapy (CBT)

Some cardiac rehabilitation programs now incorporate brief cognitive behavioural therapy delivered by trained cardiac nurses. A recent randomised trial found that just five sessions of group CBT added to standard cardiac rehabilitation led to:

Significantly greater improvement in anxiety and depression scores
Better quality of life at 6 months
Higher adherence to the rehabilitation program
Fewer cardiac-related hospital readmissions at 12 months

This shows that addressing mental health doesn't just help you feel better—it improves your physical outcomes too.

4. Social Support and Connection

The group setting of cardiac rehabilitation provides something that's hard to replicate elsewhere: connection with others who understand what you're going through. Research confirms that patients report significant benefits from the social support they receive during rehabilitation. Being around others who share similar experiences can reduce feelings of isolation and provide practical tips for recovery.

5. Building Confidence

Many patients feel anxious about physical activity after heart surgery—worried that exercise might be dangerous or trigger another heart problem. Cardiac rehabilitation provides a safe, supervised environment where you can gradually rebuild confidence in your body's abilities. This confidence often extends beyond the rehabilitation setting, helping you return to activities you enjoy.

The Evidence Is Clear

A large observational study of 522 patients with recent heart events and depression found that completing cardiac rehabilitation was associated with:

73% lower mortality compared to those who didn't complete rehabilitation
63% lower depressive symptoms

These are remarkable benefits that highlight why cardiac rehabilitation should be encouraged

for all patients, especially those experiencing depression or anxiety.

What If You're Struggling Emotionally?

If you're experiencing persistent feelings of sadness, hopelessness, anxiety, or loss of interest in activities you used to enjoy, it's important to speak up. These feelings are common and treatable. Your cardiac rehabilitation team can:

Screen you for depression and anxiety
Provide counselling and support
Refer you to mental health specialists if needed
Adjust your program to address your emotional needs

Don't let depression or anxiety prevent you from starting or continuing cardiac rehabilitation. In fact, these are additional reasons to participate, as the program can help address these challenges while improving your physical health.

The Consequences of Not Participating

Skipping cardiac rehabilitation isn't a neutral choice—it comes with real risks. Patients who don't participate in cardiac rehabilitation after bypass surgery have:

Higher death rates from heart disease and other causes
More hospital readmissions in the months and years after surgery
Greater risk of future heart attacks and need for repeat procedures
Slower recovery and longer time to return to normal activities
Lower quality of life and reduced functional capacity
Less success with lifestyle changes that protect your heart long-term

Bypass surgery addresses the immediate blockages in your arteries, but it doesn't cure coronary artery disease. Without rehabilitation and lifestyle changes, the disease can progress, and new blockages can form. Cardiac rehabilitation gives you the tools, support, and medical supervision to protect your investment in surgery.

What the Research Shows

The evidence supporting cardiac rehabilitation is overwhelming:

Participation reduces death rates by 20-30%
Hospital readmissions decrease significantly
Each additional session attended is associated with lower mortality—attending more sessions means better outcomes
Benefits extend to all patient groups, including those traditionally considered "high risk"
Both centre-based and home-based programs show similar improvements in quality of life

A recent study of over 14,000 patients with cardiovascular disease found that cardiac rehabilitation participation was associated with reduced mortality across nearly all patient subgroups — including those aged 75 and older, patients with multiple health conditions, and those with diabetes or heart failure.

Overcoming Barriers to Participation

If you're hesitant about cardiac rehabilitation, you're not alone. Common barriers include:

Transportation challenges – Ask about home-based programs or help with transport
Time constraints – Programs can often accommodate different schedules
Cost concerns – Most insurance plans cover cardiac rehabilitation; ask about financial assistance
Feeling "too sick" or "too old" – These patients often benefit most
Lack of understanding – Ask your doctor to explain the specific benefits for your situation
Depression or low motivation – This is common after heart surgery and is addressed in rehabilitation

The most important step is getting referred.

Ask your surgeon or cardiologist about cardiac rehabilitation before you leave the hospital or at your first follow-up appointment. Research shows that patients who receive a strong recommendation from their doctor are much more likely to participate.

The Bottom Line

Cardiac rehabilitation after bypass surgery isn't optional—it's an essential part of your recovery and long-term heart health. The patients who might think they don't need it or can't do it are often the ones who benefit the most.

Whether you're 50 or 85, whether you have diabetes or kidney disease, whether you're a man or a woman — cardiac rehabilitation can help you recover faster, live longer, and enjoy a better quality of life. The surgery gave your heart a second chance. Cardiac rehabilitation helps you make the most of it.

Talk to your healthcare team today about getting started. Your heart will thank you.

Have you had a heart complaint or heart surgery and want to improve your heart health? Give us a call.

At Movement for Life Physiotherapy, we understand heart health and can safely assess your tolerance to physical activity in a controlled environment. With a clear understanding of your physical capacity and a tailored management plan, we'll help get you moving to your own beat and back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Ades, P. A., Keteyian, S. J., Balady, G. J., Houston-Miller, N., Kitzman, D. W., Mancini, D. M., & Rich, M. W. (2013). Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC: Heart failure, 1(6), 540-547.
Bozkurt, B., Fonarow, G. C., Goldberg, L. R., Guglin, M., Josephson, R. A., Forman, D. E., ... & ACC’s Heart Failure and Transplant Section and Leadership Council. (2021). Cardiac rehabilitation for patients with heart failure: JACC expert panel. Journal of the American College of Cardiology, 77(11), 1454-1469.
Brown, T. M., Pack, Q. R., Aberegg, E., Brewer, L. C., Ford, Y. R., Forman, D. E., ... & Thomas, R. J. (2024). Core components of cardiac rehabilitation programs: 2024 update: a scientific statement from the American Heart Association and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation, 150(18), e328-e347.
Fleg, J. L., Forman, D. E., Berra, K., Bittner, V., Blumenthal, J. A., Chen, M. A., ... & Zieman, S. J. (2013). Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circulation, 128(22), 2422-2446.
Fletcher, G. F., Ades, P. A., Kligfield, P., Arena, R., Balady, G. J., Bittner, V. A., ... & Williams, M. A. (2013). Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation, 128(8), 873-934.
Holdgaard, A., Eckhardt-Hansen, C., Lassen, C. F., Kjesbu, I. E., Dall, C. H., Michaelsen, K. L., ... & Rasmusen, H. K. (2023). Cognitive-behavioural therapy reduces psychological distress in younger patients with cardiac disease: a randomized trial. European heart journal, 44(11), 986-996.
Jha, M. K., Qamar, A., Vaduganathan, M., Charney, D. S., & Murrough, J. W. (2019). Screening and management of depression in patients with cardiovascular disease: JACC state-of-the-art review. Journal of the American College of Cardiology, 73(14), 1827-1845.
Kulik, A., Ruel, M., Jneid, H., Ferguson, T. B., Hiratzka, L. F., Ikonomidis, J. S., ... & Zimmerman, L. (2015). Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation, 131(10), 927-964.
Kusu‐Orkar, T. E., Kermali, M., Oguamanam, N., Bithas, C., & Harky, A. (2020). Coronary artery bypass grafting: factors affecting outcomes. Journal of cardiac surgery, 35(12), 3503-3511.
Mehta, R. H., Honeycutt, E., Shaw, L. K., Milano, C. A., Smith, P. K., Harrington, R. A., & Sketch Jr, M. H. (2007). Clinical and angiographic correlates of short-and long-term mortality in patients undergoing coronary artery bypass grafting. The American journal of cardiology, 100(10), 1538-1542.
Sugiharto, F., Nuraeni, A., Trisyani, Y., Melati Putri, A., & Aghnia Armansyah, N. (2023). Barriers to participation in cardiac rehabilitation among patients with coronary heart disease after reperfusion therapy: a scoping review. Vascular health and risk management, 557-570.
Thomas, E. E., Le Grande, M., Jokhu, L. A., Goodman, A., Phillips, S., Smith, A. C., ... & Oguoma, V. M. (2026). Participation of Aboriginal and Torres Strait Islander People in Conventional Cardiac Rehabilitation Programs: Analysis of the Queensland Cardiac Outcomes Registry. Heart, Lung and Circulation.
Thomas, R. J. (2024). Cardiac rehabilitation—challenges, advances, and the road ahead. New England Journal of Medicine, 390(9), 830-841.
Thomas, R. J., Beatty, A. L., Beckie, T. M., Brewer, L. C., Brown, T. M., Forman, D. E., ... & Whooley, M. A. (2019). Home-based cardiac rehabilitation: a scientific statement from the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology. Circulation, 140(1), e69-e89.
Thomas, R. J., King, M., Lui, K., Oldridge, N., Piña, I. L., Spertus, J., ... & Whitman, G. R. (2007). AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services: endorsed by the American college of chest physicians, American college of sports medicine, American physical therapy association, Canadian association of cardiac rehabilitation, European association for cardiovascular prevention and rehabilitation, inter-American heart foundation, national association of clinical nurse specialists, preventive .... Journal of the American college of Cardiology, 50(14), 1400-1433.

Heart Health - Life After Bypass Surgery

Wed, 01 Apr 2026 04:54:26 GMT

Exercise and lifestyle changes are essential following bypass surgery.

Bypass surgery is a life-changing procedure that restores blood flow to the heart, reducing symptoms of coronary artery disease. However, recovery doesn't end in the operating room—it's a journey that requires patience, rehabilitation, and lifestyle changes. This guide will walk you through what to expect after surgery and how to safely return to YOUR LIFE with confidence.

Who Gets Bypass Surgery?

Bypass surgery is typically recommended for people with severe coronary artery disease, a condition where the arteries supplying blood to your heart become narrowed or blocked. Several risk factors increase your likelihood of developing this condition:

High blood pressure
High cholesterol
Smoking
Obesity
Diabetes
Sedentary lifestyle
Family history of heart disease

The decision to proceed with surgery depends on multiple factors: the size and location of the blockage, the severity of your symptoms (such as chest pain or shortness of breath), and whether conservative treatments—including medication, exercise, and diet changes—have been unsuccessful in managing your condition.

Understanding Your Heart: Anatomy 101

Your heart relies on coronary arteries to supply oxygen-rich blood to the heart muscle itself. When these arteries become blocked due to plaque buildup (a process called atherosclerosis), blood flow is restricted, increasing the risk of heart attacks and chest pain (angina).

Coronary artery bypass surgery creates a new route for blood flow by using a healthy blood vessel from another part of the body—typically the leg (saphenous vein), arm (radial artery), or chest (internal thoracic artery)—to bypass the blockage. This procedure improves circulation and heart function, helping relieve symptoms and reduce your risk of future heart problems.

While bypass surgery dramatically improves blood flow, it does not cure coronary artery disease or prevent future blockages from forming.

This is why rehabilitation, physiotherapy, and lifestyle changes are essential for long-term heart health and preventing disease progression.

The First Few Weeks After Surgery: What to Expect

Most patients stay in the hospital for 5 to 7 days after bypass surgery. Complete recovery typically takes 6 to 12 weeks, though this varies based on your age, overall health, and any complications. Recovery in the early weeks focuses on healing, preventing complications, managing pain, and gradually increasing activity. During this time, you should:

1. Breathing and Movement:

Perform breathing and coughing exercises several times daily to prevent lung complications
Start walking short distances (5-10 minutes) within the first week after discharge
Gradually increase walking duration each week, working up to 30-60 minutes daily

2. Activity Restrictions:

Avoid heavy lifting (generally nothing over 5-10 pounds) for 6-8 weeks
Avoid pushing, pulling, or reaching overhead until your sternum (breastbone) heals
Follow your surgeon's specific guidelines about driving (typically 4-6 weeks)
Avoid strenuous activities that strain your chest

3. Wound Care:

Keep incision sites clean and dry
Watch for signs of infection (increased redness, swelling, drainage, or fever)
Report any concerning symptoms to your healthcare team immediately

4. Pain Management:

Take prescribed pain medications as directed
Expect some chest discomfort, especially around the incision site
Use a pillow to support your chest when coughing or sneezing

5. Lifestyle Priorities:

Follow a heart-healthy diet low in saturated fats and sodium
Practice stress management techniques
Get adequate sleep to support healing
Attend all follow-up appointments

Mental Health Matters: The Emotional Side of Recovery

Emotional well-being is just as important as physical recovery. Research shows that anxiety and depression affect nearly 50% of patients after heart surgery, with depression rates ranging from 14% to 43% before surgery and about 20% remaining depressed afterward.

Common emotional experiences include:

Feeling anxious or worried about your recovery
Experiencing mood swings or irritability
Feeling depressed or low in spirit
Worrying about returning to normal activities
Concerns about future heart problems

The good news: Depression and anxiety symptoms typically improve within the first year after surgery, especially with proper support and treatment. Studies show that interventions such as cognitive behavioural therapy, counselling, and cardiac rehabilitation programs can significantly improve mental health outcomes and quality of life.

What you can do:

Talk openly with your healthcare providers about how you're feeling
Consider joining a support group for heart surgery patients
Stay connected with family and friends
Participate in cardiac rehabilitation, which has been shown to reduce depressive symptoms
Don't hesitate to seek professional help if feelings of depression or anxiety persist

For additional support and patient stories, visit:

How Long Will It Take to Get Back to My Life?

Recovery times vary from person to person based on age, overall health, and the complexity of your surgery. However, general guidelines suggest:

2-4 weeks: Light activity

Walking around your home and neighbourhood
Light household tasks (folding laundry, preparing simple meals)
Self-care activities (showering, dressing)

6-8 weeks: Returning to work

Office jobs and sedentary work
Gradual return to daily routines
Driving (with your doctor's approval)

8-12 weeks: Resuming recreational activities

Golf, swimming, or light sports
More vigorous household tasks
Sexual activity (discuss timing with your doctor)

3-6 months: Full recovery

High-intensity exercise and activities
Return to all pre-surgery activities
Optimal physical conditioning

Remember: These are general timelines. Your individual recovery may be faster or slower. Always follow your healthcare team's specific recommendations and progress at your own pace.

The Power of Cardiac Rehabilitation

Cardiac rehabilitation is strongly recommended for all patients after bypass surgery—it's considered a Class I recommendation (the highest level) by the American College of Cardiology and American Heart Association. This means the evidence supporting its benefits is overwhelming.

What is cardiac rehabilitation?

Cardiac rehabilitation is a comprehensive, medically supervised program that includes:

Structured exercise training tailored to your fitness level
Education about heart disease and risk factors
Nutritional counselling for heart-healthy eating
Psychological support and stress management
Medication management and monitoring
Support for lifestyle changes

Cardiac rehabilitation has numerous proven benefits. Research demonstrates that cardiac rehabilitation significantly:

Reduces risk of death by 20-30%
Decreases hospital readmissions
Improves cardiovascular fitness and exercise capacity
Helps manage symptoms like chest pain and shortness of breath
Lowers risk of future cardiac events
Increases confidence and independence
Provides emotional and psychological support
Improves quality of life
Reduces healthcare costs

You should be referred to cardiac rehabilitation either before hospital discharge or during your first outpatient visit. Recent evidence shows that starting rehabilitation as early as 2 weeks after surgery (rather than waiting the traditional 6 weeks) is safe and may accelerate recovery, though your doctor will determine the best timing for you.

Program options:

Centre-based programs: Traditional supervised exercise at a cardiac rehabilitation facility
Home-based programs: Structured programs you complete at home with remote monitoring
Hybrid programs: Combination of centre-based and home-based activities

Both centre-based and home-based cardiac rehabilitation have been shown to produce similar improvements in quality of life and outcomes. The best program for you is the one you'll attend and complete . You can learn more about cardiac rehabilitation here .

Essential Lifestyle Changes for Long-Term Success

Bypass surgery gives you a second chance at heart health but maintaining that improvement requires lifelong commitment to healthy habits. Think of these changes not as restrictions, but as investments in your future.

1. Medications (Take as Prescribed)

Your doctor will prescribe several medications to protect your heart and grafts:

Aspirin: Lifelong antiplatelet therapy (typically 81 mg daily)
Statins: High-intensity cholesterol-lowering medication for all patients
Beta-blockers: Especially if you've had a heart attack or have reduced heart function
ACE inhibitors: If you have diabetes or reduced heart function
Other medications: As needed for blood pressure, diabetes, or other conditions

2. Quit Smoking (The Single Most Important Change)

If you smoke, quitting is the most important thing you can do for your heart. Smoking cessation reduces your risk of recurrent heart problems by 50% and significantly improves graft survival. Ask your healthcare team about smoking cessation programs, medications, and support resources.

3. Eat a Heart-Healthy Diet

Follow a Mediterranean-style diet rich in:

Fruits and vegetables
Whole grains
Lean proteins (fish, poultry, legumes)
Healthy fats (olive oil, nuts, avocados)
Limited saturated fats, trans fats, and sodium

Studies show that maintaining a Mediterranean diet after heart surgery reduces the risk of

recurrent heart problems and death by up to 62%.

4. Stay Physically Active

Regular exercise is crucial for maintaining heart health:

Aim for at least 150 minutes of moderate-intensity exercise per week
Include both aerobic exercise (walking, cycling, swimming) and strength training
Start slowly and gradually increase intensity
Make physical activity a permanent part of your routine

Research shows that patients who exercise regularly after bypass surgery have a 31% lower risk

of death and 51% lower risk of recurrent heart problems.

5. Maintain a Healthy Weight

If you're overweight, losing even 5-10% of your body weight can significantly improve heart health, blood pressure, cholesterol, and diabetes control.

6. Manage Stress

Chronic stress affects heart health. Practice stress-reduction techniques such as:

Deep breathing exercises
Meditation or mindfulness
Yoga or tai chi
Hobbies and activities you enjoy
Spending time with loved ones

7. Control Other Risk Factors

Work with your healthcare team to manage:

Blood pressure (target: less than 130/80 mmHg)
Cholesterol (LDL goal: less than 70 mg/dL)
Blood sugar (if you have diabetes)

8. Attend All Follow-Up Appointments

Regular check-ups allow your healthcare team to monitor your progress, adjust medications, and catch any problems early.

The Take Home Message

Bypass surgery is just the first step toward better heart health. Long-term success depends on three pillars:

1. Early rehabilitation: Starting a cardiac rehabilitation program as soon as your doctor recommends

2. Structured physiotherapy: Following a progressive exercise program tailored to your needs

3. Lifestyle changes: Committing to heart-healthy habits for life

With the right support, dedication, and medical care, you can return to an active, fulfilling life. Studies show that patients who engage in cardiac rehabilitation and maintain healthy lifestyle changes can expect significant improvements in quality of life, reduced symptoms, and better long-term outcomes.

Remember: You're not alone on this journey. Your healthcare team, cardiac rehabilitation professionals, family, and support networks are all here to help you succeed. Take it one day at a time, celebrate your progress, and stay committed to your heart health.

Your heart has been given a second chance—make the most of it.

Have you had bypass surgery and want to improve your heart health? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Alexander, J. H., & Smith, P. K. (2016). Coronary-Artery Bypass Grafting. The New England journal of medicine, 374(20), 1954–1964. https://doi.org/10.1056/NEJMra1406944
Booth III, J. N., Levitan, E. B., Brown, T. M., Farkouh, M. E., Safford, M. M., & Muntner, P. (2014). Effect of sustaining lifestyle modifications (nonsmoking, weight reduction, physical activity, and mediterranean diet) after healing of myocardial infarction, percutaneous intervention, or coronary bypass (from the REasons for Geographic and Racial Differences in Stroke Study). The American journal of cardiology, 113(12), 1933-1940.
Caspi-Avissar, N., Grosman-Rimon, L., Gohari, J., Arazi, M., Granot, D., Ghanim, D., Carasso, S., Shalabi, A., Sudarsky, D., Eilat-Adar, S., Kinany, W., Amir, O., & Kachel, E. (2021). Clinical, Surgical, and Sociopsychological Factors and Depression After Cardiothoracic Surgery. The Annals of thoracic surgery, 111(3), 1064–1070. https://doi.org/10.1016/j.athoracsur.2020.05.130
Doyle, M. P., Indraratna, P., Tardo, D. T., Peeceeyen, S. C., & Peoples, G. E. (2019). Safety and efficacy of aerobic exercise commenced early after cardiac surgery: a systematic review and meta-analysis. European Journal of Preventive Cardiology, 26(1), 36-45.
Ennis, S., Lobley, G., Worrall, S., Evans, B., Kimani, P. K., Khan, A., ... & McGregor, G. (2022). Effectiveness and safety of early initiation of poststernotomy cardiac rehabilitation exercise training: the SCAR randomized clinical trial. JAMA cardiology, 7(8), 817-824.
Gaudino, M., Andreotti, F., & Kimura, T. (2023). Current concepts in coronary artery revascularisation. Lancet (London, England), 401(10388), 1611–1628. https://doi.org/10.1016/S0140-6736(23)00459-2
Kulik, A., Ruel, M., Jneid, H., Ferguson, T. B., Hiratzka, L. F., Ikonomidis, J. S., ... & Zimmerman, L. (2015). Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation, 131(10), 927-964.
Lawton, J. S., Tamis-Holland, J. E., Bangalore, S., Bates, E. R., Beckie, T. M., Bischoff, J. M., ... & Zwischenberger, B. A. (2022). 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 145(3), e4-e17.
Rosson, S., Monaco, F., Miola, A., Cascino, G., Stubbs, B., Correll, C. U., Firth, J., Ermis, C., Perrotti, A., Marciello, F., Carvalho, A. F., Brunoni, A. R., Fusar-Poli, P., Fornaro, M., Gentile, G., Granziol, U., Pigato, G., Favaro, A., & Solmi, M. (2021). Longitudinal Course of Depressive, Anxiety, and Posttraumatic Stress Disorder Symptoms After Heart Surgery: A Meta-Analysis of 94 Studies. Psychosomatic medicine, 83(1), 85–93. https://doi.org/10.1097/PSY.0000000000000872
Williams, M. S., Levine, G. N., Kalra, D., Agarwala, A., Baptiste, D., Cigarroa, J. E., ... & Tamis-Holland, J. E. (2025). 2025 AHA/ACC clinical performance and quality measures for patients with chronic coronary disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Performance Measures. Circulation: Cardiovascular Quality and Outcomes, 18(6), e000140.

NDIS - Down Syndrome

Wed, 01 Apr 2026 03:58:57 GMT

Exploring NDIS Physiotherapy Services for People with Down Syndrome in Australia: A Comprehensive Guide

Down syndrome is one of the most common chromosomal conditions in Australia. Down Syndrome affects around 1 in every 1,158 births in Australia. Down Syndrome Australia reports that between 2016 and 2020, there were an estimated 265 babies born with Down syndrome each year. Individuals with Down Syndrome often experience a range of physical, cognitive, and emotional challenges.

Physiotherapy services can play a critical role in improving the quality of life for these

individuals by addressing their unique needs (Cioni et al., 2011).

In Australia, the National Disability Insurance Scheme (NDIS) may fund physiotherapy when it is related to a person's disability and helps build or maintain functional skills and independence (NDIS, 2025). Physiotherapy can support movement, strength, balance, posture, motor development, mobility and participation in everyday life.

This blog explains what Down Syndrome is, how it commonly presents, how it may affect quality of life, and how NDIS physiotherapy services can support individuals with Down Syndrome in Australia.

What is Down syndrome?

Down syndrome is a genetic condition caused by an extra copy of chromosome 21, often referred to as trisomy 21. It occurs at conception and is not caused by anything a parent did or did not do. People with Down syndrome have a wide range of strengths, abilities and support needs, and no two individuals present in exactly the same way (Healthdirect Australia, 2024).

Down syndrome is also the most common genetic cause of intellectual disability.

With the right supports, health care and inclusive opportunities, many people with Down Syndrome participate in education, employment, sport, family life and community life in meaningful ways (Healthdirect Australia, 2024).

How Down syndrome may present

Down syndrome can affect physical development, learning, communication and health. Common features may include developmental delay, hypotonia or low muscle tone, joint laxity, reduced strength, delayed gross motor milestones, and intellectual disability of varying degrees (DSA, 2024).

People with Down syndrome are also more likely to experience associated health conditions such as congenital heart disease, hearing and vision difficulties, thyroid disorders, sleep apnoea, coeliac disease, obesity and some musculoskeletal concerns.

Does the NDIS fund physiotherapy for people with Down syndrome?

Yes. The NDIS may fund physiotherapy when it is considered a disability-related support and is likely to help the participant build or maintain functional capacity, independence or participation.

To access NDIS Down Syndrome physiotherapy services, individuals must first be deemed eligible for the NDIS. This involves meeting specific age, residency, and disability criteria (NDIS, 2025). Once eligibility is confirmed, a tailored NDIS plan will be developed, outlining the support and services that an individual requires, including physiotherapy.

To find NDIS-registered physiotherapy providers, individuals can use the NDIS Provider Finder tool, available on the NDIS website (NDIS, 2026). Additionally, healthcare professionals, such as general practitioners, pediatricians, and other therapists, can provide recommendations and referrals for suitable physiotherapy services.

Physiotherapy Services Under the NDIS

Physiotherapy services are an integral component of NDIS support packages for individuals with Down Syndrome. These services aim to address a range of physical challenges, including muscle strength, motor skills, balance, and coordination (Cioni et al., 2011).

Physiotherapy focuses on movement, function and participation and is especially beneficial when introduced early in a child's life, as it can help improve motor development, promote independence, and prevent secondary complications (Cioni et al., 2011).

For babies and children, physiotherapy often targets motor development such as rolling, sitting, crawling, standing, walking, jumping and stair climbing. For adolescents and adults, it may focus more on posture, gait, strength, balance, falls prevention, pain management, exercise participation and maintaining mobility over time (DSA, 2024; NDIS, 2025).

NDIS physiotherapy should be individualised and goal-based. Depending on age and need, physiotherapy goals may include improving gross motor skills, increasing strength and endurance, building balance and coordination, supporting posture and joint stability, improving walking efficiency, reducing falls, increasing confidence in community settings, and helping families or support workers implement home-based strategies (NDIS, 2025).

The Take Home

NDIS Down Syndrome physiotherapy services play a vital role in supporting the physical development and well-being of individuals with Down Syndrome in Australia. By accessing these services through the NDIS, individuals with Down Syndrome can continue to build skills, participate in their communities and improve quality of life across the lifespan (Healthdirect Australia, 2024). Contact us today. To find out how we can support your Physiotherapy goals!

Are you looking for goal-oriented therapy to assist with Down Syndrome? Then give us a call.

If you or your child has Down Syndrome and you are exploring physiotherapy through the NDIS, start with goals that matter in everyday life. Call us today to find out how we can help you achieve your goals and increase your independence. All our clients are individually assessed, and programs tailored to your specific needs. We are the only QIP Accredited Physiotherapy services in the Northern Territory and an approved NDIS provider.

References

Down Syndrome Australia. (2024). Get Active Resource Workbook. https://www.downsyndrome.org.au/qld/wp-content/uploads/sites/7/2024/07/Get-Active-Resource-booklet-v11.pdf
Down Syndrome Australia. (n.d.-a). Population statistics. https://www.downsyndrome.org.au/about-down-syndrome/statistics/population-statistics/
National Disability Insurance Scheme. (2025a, October 23). Therapy supports. https://www.ndis.gov.au/understanding/supports-funded-ndis/therapy-supports
National Disability Insurance Scheme. (2025b). Supports funded by the NDIS. https://www.ndis.gov.au/understanding/supports-funded-ndis
National Disability Insurance Scheme. (2025d). Am I eligible? https://www.ndis.gov.au/applying-access-ndis/am-i-eligible
National Disability Insurance Scheme. (2026). Allied health providers. https://www.ndis.gov.au/providers/working-provider/allied-health-providers
Royal Children's Hospital Melbourne. (2026). Screening for children with Down syndrome. https://www.rch.org.au/genmed/clinical_resources/Screening_for_children_with_Down_Syndrome/

NDIS - Understanding Cerebral Palsy

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 01 Apr 2026 01:01:48 GMT

CP affects 1 in 700 births in Australia. How does physio help?

Cerebral Palsy (CP) is a permanent neurological condition that affects movement and posture. It is the most common physical disability in childhood. In Australia the prevalence of CP has fallen from 2.5 per 1,000 live births in 1997-98 to 1.5 per 1,000 live births in 2015-16. This suggests the prevalence of Cerebral Palsy is decreasing due to advances in research and technology. Currently 1 in 700 babies are born with Cerebral Palsy each year (Cerebral Palsy Alliance 2023).

Although Cerebral Palsy is defined as a non-progressive injury to the

developing brain, its impact changes across the lifespan.

Babies and children may experience delayed motor milestones, while adolescents and adults may face ongoing challenges with mobility, pain, fatigue, participation, and musculoskeletal health (National Institute for Health and Care Excellence 2019/2024).

For many people with Cerebral Palsy, physiotherapy is a core part of support. This blog goes into more detail about what Cerebral Palsy is, how it presents, and how NDIS physiotherapy services can help children, adolescents, and adults with Cerebral Palsy in Australia.

What is Cerebral Palsy?

Cerebral Palsy, or CP, is an umbrella term for a group of disorders that affect a person’s ability to move and maintain posture. In most cases, it is caused by an injury to the developing brain during pregnancy, around the time of birth, or in the first years of life (Royal Children’s Hospital Melbourne, 2025).

Cerebral Palsy is permanent, but the brain injury itself is non-progressive. That means the original injury does not continue to worsen over time. However, the way Cerebral Palsy affects the body can change as a person grows, ages, and encounters different physical demands across school, work, parenting, and community life (CPA, 2025; NICE, 2019/2024).

How Does Cerebral Palsy Present?

Cerebral Palsy can range from very mild to very complex and presents differently from person to person. It is classified by 3 main factors:

The type of movement disorder - based on the area of the brain that is affected, which may result in spastic, ataxic or dyskinetic movement patterns.
The functional level of the person is classified using the Gross Motor Function Classification System (GMFCS), which classifies motor impairment on a scale of 1 – 5 based on sitting, walking and mobility needs.
The area of the body affected, further classifies a presentation as bilateral quadriplegia, bilateral diplegia, or unilateral hemiplegia.

Common signs and symptoms of CP can include:

Difficulty with posture, balance and coordinated movement
Delayed milestones such as rolling, sitting, crawling or walking
Muscle stiffness or spasticity
Involuntary movements or fluctuating muscle tone
Reduced strength, endurance and motor control
Walking differences, falls, or difficulty with stairs and uneven ground
Challenges with hand function, self-care or mobility

Cerebral Palsy also commonly occurs alongside other health and developmental needs.

The Cerebral Palsy Alliance reports that around 1 in 4 children with CP cannot talk, 1 in 4 cannot walk, 1 in 2 have an intellectual disability, and 1 in 4 have epilepsy (CPA, 2026).

Depending on the individual, CP may also affect eating, sleep, communication, vision, hearing, pain, continence, and participation in school, sport and work (CPA, 2025).

How Can Cerebral Palsy Affect Quality of Life?

Cerebral Palsy can affect quality of life in physical, emotional, social and practical ways. Mobility challenges can influence how easily someone moves around home and participates in school, work and community life. Pain, fatigue, muscle tightness, falls, poor sleep and reduced endurance can all make activities of daily living challenging.

Pain is a major concern for people living with Cerebral Palsy. Pain is often linked to factors including contractures, posture, dystonia and hip subluxation. Pain may interfere with community participation, leading to social isolation.

Where Does Physiotherapy Fit In?

Physiotherapy is a core support for many people with Cerebral Palsy. It can support people to build or maintain functional capacity, reduce secondary complications, improve movement efficiency, prescribe assistive technology and participate more fully in every day life.

Depending on the individual person, physiotherapy may help with:

Gross motor development such as rolling, sitting, standing and walking
Strength, endurance and physical conditioning
Gait training and community mobility
Balance, falls prevention and confidence
Postural management, transfers and positioning
Pain management and movement strategies
Exercise programs for lifelong physical activity
Education for parents, carers and support workers

NDIS Physiotherapy Services for People with Cerebral Palsy

The NDIS may fund physiotherapy for children and adults with Cerebral Palsy where it is considered a disability-related support and meets the scheme’s requirements. The NDIA’s current Therapy Supports guideline states that therapy supports must be evidence-based and aimed at building or maintaining skills and independence (NDIA, 2025a).

Evidence suggests that physiotherapy works best when it is specific, goal-directed, sufficiently intensive, and linked to meaningful activities (Gonzalez et al., 2023; Passos et al., 2025).

In practice, NDIS-funded physiotherapy for CP may include assessment, treatment, exercise prescription, mobility training, falls prevention, equipment advice, report writing, carer training and support for home or community-based routines, as long as these supports are linked to the participant’s goals and evidence of need (NDIA, 2025). Therapy can be funded for capacity building to develop new skills, or for maintenance when it helps slow loss of function or maintain participation (NDIA, 2025).

For children under 9, the NDIS early childhood approach may be relevant. The NDIA notes that children younger than 9 and their families can receive support through the early childhood approach, and children younger than 6 do not need a diagnosis to access some supports where there are developmental concerns (NDIA, 2025).

Good physiotherapy changes with the person. In early childhood, the focus may be on developmental milestones and family coaching. In school years, it may shift toward mobility, play, sport and school access. In adulthood, therapy often centres on maintaining function, managing pain, reducing secondary complications and supporting long-term health and independence.

Did you Know?

From ancient Greeks to the Egyptian Pharoah’s to Roman Emperors, CP has afflicted civilisations across the globe since 1580 B.C. While there is evidence in hieroglyphics of CP, it wasn’t until the fifth to the fourth century B.C. that Hippocrates first recognised and discussed the presence of brain damage in newborns, a sometimes result of premature birth, congenital infection, and prenatal stress.

Over the centuries, CP has been a topic of medicine, art, even culture (there is a painting of a child with clubfoot and left spastic hemiparesis in the Louvre, Paris), with significant contributions more recently from William John Little, William Osler, and Sigmund Freud. This rich history, writings and recordings have allowed academics to track the evolution of Cerebral Palsy – from physical and psychological symptoms through to advancements in diagnosis and treatment including medical imaging, the use of botulinum toxin (botox), orthopaedic procedures, and more recently high intensity exercise.

The Take Home

Cerebral Palsy is a lifelong condition, but the right supports can make a significant difference to mobility, independence, participation and quality of life. Physiotherapy is often central to that support.

Are you looking for goal-oriented therapy to assist with Cerebral Palsy? Then give us a call.

If you or your child has Cerebral Palsy and you are exploring physiotherapy through the NDIS, start with goals that matter in everyday life. Call us today to find out how we can help you achieve your goals and increase your independence! All our clients are individually assessed, and programs tailored to your specific needs. We are the only QIP Accredited Physiotherapy services in the Northern Territory and an approved NDIS provider.

References

American Academy for Cerebral Palsy and Developmental Medicine. (n.d.). Early detection of cerebral palsy. https://www.aacpdm.org/publications/care-pathways/early-detection-of-cerebral-palsy
Cerebral Palsy Alliance. (2023). Australian Cerebral Palsy Register report 2023. https://cerebralpalsy.org.au/wp-content/uploads/2023/06/2023-ACPR-Report.pdf
Cerebral Palsy Alliance. (2025a). What is cerebral palsy? https://cerebralpalsy.org.au/cerebral-palsy/
Cerebral Palsy Alliance. (n.d.-a). How does cerebral palsy affect people? https://cerebralpalsy.org.au/cerebral-palsy/how-affect/
Cerebral Palsy Alliance. (n.d.-b). Gross Motor Function Classification System (GMFCS). https://cerebralpalsy.org.au/cerebral-palsy/gross-motor-function-classification-system/
Dimakopoulos, R., Vakalaki, T., Spinou, A., Michopoulos, I., & Papadopoulou, M. (2024). Effectiveness of therapeutic interventions on participation in children with cerebral palsy: A systematic review and meta-analysis. Child: Care, Health and Development, 50(4), e13301. https://doi.org/10.1111/cch.13301
Gonzalez, N. A., Sanivarapu, R. R., Patel, P. P., Mahajan, K. S., Haddad, C. Y., Hassan, N. S., Phan, S. V., Nwosu, K., Yelamanchi, A., Irshad, M., Ladna, A. A., Manzoor, J., Kannan, T. H., Jiwani, F. M., Haq, I. U., & Jafri, S. M. A. (2023). Physical therapy interventions in children with cerebral palsy: A systematic review. Cureus, 15(8), e43084. https://doi.org/10.7759/cureus.43084
National Disability Insurance Agency. (2025a). Therapy supports. https://www.ndis.gov.au/media/8091/download?attachment=
National Disability Insurance Agency. (n.d.-b). The early childhood approach for children younger than 9. https://www.ndis.gov.au/understanding/families-and-carers/early-childhood-approach-children-younger-9
National Institute for Health and Care Excellence. (2019/2024). Cerebral palsy in adults (NICE Guideline NG119). https://www.nice.org.uk/guidance/ng119
Passos, A. A., Santos, F. O. A., Arida, R. M., Brogin, J. A. F., Faber, J., López-Ortiz, C., & Teixeira-Machado, L. (2025). Enhancing quality of life in individuals with cerebral palsy: A systematic review and meta-analysis of physiotherapy interventions. Disability and Rehabilitation, 47(16), 4040-4062. https://doi.org/10.1080/09638288.2024.2443040

Massage Therapy - Pre and Post Natal

Tue, 18 Nov 2025 05:08:33 GMT

Prenatal and postnatal massage can reduce stress, anxiety, and depression, and ease musculoskeletal-related pain.

Pregnancy and early motherhood are physically and emotionally transformative experiences. Prenatal and postnatal massage therapy is increasingly recognized as a safe, non-pharmacologic adjunct for improving maternal well-being and addressing common physical and psychological symptoms associated with pregnancy and the postpartum period.

When performed safely and professionally by a qualified therapist, it can ease discomfort, support recovery, and enhance emotional wellbeing throughout the childbearing journey.

This comprehensive guide explores the latest scientific findings, clinical guidelines, and practical safety advice, ensuring you can make informed decisions during and after pregnancy.

What Is Prenatal and Postnatal Massage?

Prenatal massage is adapted for the needs of pregnant women, focusing on gentle, comforting touch to ease physical and emotional discomforts of pregnancy. Postnatal massage is designed for mothers who have recently given birth, supporting postpartum recovery, relieving muscular tension, and promoting emotional wellness. Both types utilize specialized techniques and therapist training to ensure safety and comfort.

Benefits of Prenatal Massage

Modern clinical research and consensus guidelines highlight an impressive list of evidence-backed benefits:

Pain Relief & Musculoskeletal Support: Prenatal massage is proven to reduce lower back and pelvic pain, leg cramps, and joint discomfort—issues common during pregnancy due to shifting posture and weight gain.
Reduced Swelling & Improved Circulation: Gentle massage stimulates both blood and lymphatic flow, reducing oedema and helping the body manage its increased fluid demands.
Enhanced Sleep Quality: Massage can promote deeper, more restorative sleep, countering the sleep disturbances so frequent in the third trimester.
Lowered Stress and Anxiety: Research consistently demonstrates that massage lowers cortisol levels and increases mood-stabilizing hormones, with positive impacts on both mother and developing baby.
Labor Preparation: Certain techniques can reduce anxiety in late pregnancy, help regulate breathing, and decrease pelvic muscle tension, supporting a more positive birth experience. Spouse- or partner-administered massage during labor can reduce pain and shorten the first stage, complementing professional care.

Benefits of Postnatal Massage

After birth, massage continues to provide vital physical and emotional benefits:

Aiding Recovery: Supports healing, especially after Caesarean or challenging births, by reducing swelling and enhancing blood flow to recovering tissues.
Easing Muscular Tension: Relieves shoulder, neck, and back pain from breastfeeding, lifting, and caring for a newborn.
Hormonal & Mood Support: Studies show regular postnatal massage reduces symptoms of anxiety and depression—including the “baby blues”—and improves mood by balancing key hormones.
Better Sleep: Supporting restorative sleep is crucial for new mothers adjusting to an unpredictable schedule.
Mother-Infant Bonding: Emerging research demonstrates that both receiving and administering soothing massage (such as infant massage) can strengthen mother-infant attachment and boost maternal confidence.

Safety Considerations: Guidelines, Contraindications, and Referral Criteria

Renowned organizations such as the American Congress of Obstetricians and Gynecologists (ACOG) and the American Massage Therapy Association (AMTA) stress that, when provided by trained professionals, prenatal and postnatal massage are generally safe for healthy pregnancies—but emphasize important precautions:

Contraindications:
High-risk pregnancies (e.g., pre-eclampsia, severe gestational hypertension, deep vein thrombosis, significant bleeding, or placenta previa)
Unexplained abdominal symptoms, severe swelling, persistent headaches, or sudden changes in vision
Open wounds, skin infections, fever, or contagious illness

Referral Criteria and Standards of Care:

You do not need a referral to get massage therapy if you are pre- or postnatal, however we recommend you obtain clearance from your doctor or midwife if you have medical complications.

Our top tips:

Always choose therapists with formal accreditation in prenatal/postnatal massage
AMTA states side-lying positions and specialized bolstering should be used to avoid pressure on the abdomen and to support maternal blood flow
ACOG advises against deep tissue techniques, abdominal work (unless specifically prescribed), and pressure points linked to uterine contractions unless guided by a healthcare provider
Seek immediate referral to a healthcare provider if severe or sudden symptoms develop during a session (e.g., dizziness, chest pain, significant uterine cramping).

Appropriate Techniques and Areas of Focus

Safe prenatal and postnatal massage share a gentle, supportive approach. Techniques such as Swedish massage (long, gentle strokes), light effleurage, and lymphatic drainage are recommended. Deep tissue work, myofascial release, or vigorous approaches should be avoided unless advised by a specialist.

Your therapist will likely focus on your lower back, hips, legs, shoulders, and neck as these bear most of the strain during pregnancy and newborn-care. Therapists will generally avoid deep pressure on the inner legs (risk of clot formation) and direct abdominal manipulation.

Best Practices for Body Positioning

Proper positioning is essential for comfort and safety:

Prenatal: Side-lying with supportive pillows and bolsters is preferred, particularly in the second and third trimesters. Semi-reclined positioning is also common. Lying flat on the back (supine) for extended periods is avoided due to possible reduced blood flow.
Postnatal: Sessions are adapted to any ongoing discomfort or healing, including surgical wounds or sore tissues. Comfort and accessibility are prioritized, with frequent adjustments during the session as needed.

Choosing Your Massage Therapist

Before commencing massage therapy, confirm your therapist has specialized training and certification in prenatal and postnatal massage. Ask about their familiarity with current safety guidelines, contraindications, and individualized care plans, and seek out practitioners who work collaboratively with your health care team, especially if you have risk factors.

The Take Home

Prenatal and postnatal massage, when performed safely and professionally, offer meaningful benefits for mothers—helping to ease discomfort, support recovery, and enhance emotional resilience and wellbeing throughout the childbearing journey. When conducted according to clinical guidelines and by trained professionals, it provides comfort, reduces pain, improves mood, and supports both mothers and infants on the journey to well-being.

Are you pregnant, stressed, or just tired and sore? Give us a call and let our qualified pre- and postnatal massage therapist look after you.

At Movement for Life Physiotherapy, we have a fully qualified remedial massage therapist who is trained in a range of therapeutic techniques, including prenatal and postnatal therapy, who works with our clinical team to achieve outstanding results for you.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Chen P-H, Kao C-H, Gou S-C, Liu C-Y, Wang P, Shih C-L. (2025). Effects of Massages Administered by Spouses on Labor Pain and Delivery Duration among Primiparous Women. Sage Open Nursing. 11. doi: 10.1177/23779608251366751
Crider, C. (2023). Postpartum massage can help recovery after birth. Healthline. https://www.healthline.com/health/postpartum-massage
Fogarty, S., Barnett, R., & Hay, P. (2020). Safety and Pregnancy Massage: a Qualitative Thematic Analysis. International journal of therapeutic massage & bodywork, 13(1), 4–12.
Fogarty, S., Steel, A., Hall, H., & Hay, P. (2020). Australian massage therapists’ views and practices related to preconception, pregnancy and the early postpartum period. Complementary therapies in clinical practice, 40, 101222.
Geary, O., Grealish, A., & Bright, A. M. (2023). The effectiveness of mother-led infant massage on symptoms of maternal postnatal depression: A systematic review. PloS one, 18(12), e0294156. https://doi.org/10.1371/journal.pone.0294156
Hall, H. G., Cant, R., Munk, N., Carr, B., Tremayne, A., Weller, C., ... & Lauche, R. (2020). The effectiveness of massage for reducing pregnant women's anxiety and depression; systematic review and meta-analysis. Midwifery, 90, 102818.
Massage and Myotherapy Australia (n.d). Pregnancy Massage Guidelines. Accessed 18 ^th November 2025. https://www.massagemyotherapy.com.au/Tenant/U0000012/00000001/PDF/Polices%20and%20Procedures/Pregnancy%20Massage%20-%20Guidelines.pdf
Mueller, S. M., & Grunwald, M. (2021). Effects, Side Effects and Contraindications of Relaxation Massage during Pregnancy: A Systematic Review of Randomized Controlled Trials. Journal of clinical medicine, 10(16), 3485. https://doi.org/10.3390/jcm10163485
RACGP (2025). Antenatal perineal massage: reduce perineal injury during childbirth
Salaman, M. (2018). Massage and Pregnancy: A Powerful Combination. American Massage Therapy Association. https://www.amtamassage.org/publications/massage-therapy-journal/massage-and-pregnancy-a-powerful-combination/
Shetty, S. L. P., & Fogarty, S. (2021). Massage during pregnancy and postpartum. Clinical obstetrics and gynecology, 64(3), 648-660.
Soronio, A (2025). Prenatal to postnatal massage for mothers. https://getblys.com.au/blog/prenatal-postnatal-massage-mothers/
Uncu, B., & Gök, H. (2025). The Effect of Newborn Massage Training on Maternal Attachment and Postpartum Depression: Randomized Controlled Trial. Nursing & health sciences, 27(2), e70112. https://doi.org/10.1111/nhs.70112

Massage Therapy - Foot Reflexology

Mon, 17 Nov 2025 23:40:53 GMT

How foot reflexology can help reduce pain, stress and anxiety and compliment other health care strategies.

Foot reflexology is a widely practiced modality in complementary and alternative medicine, showing pronounced benefits for physical and mental health when applied judiciously and with professional care. As a specialized therapy, it involves applying targeted pressure to specific reflex points on the feet, which are believed to correspond with organs, glands, and other structures throughout the body. Unlike a conventional foot massage, which typically centres on relaxation and relieving muscular tension, reflexology takes a holistic approach rooted in the theory that stimulating certain zones on the foot can promote healing and balance in distant or underlying body systems.

Professional practitioners train to map and manipulate these reflex zones purposefully, seeking therapeutic outcomes beyond simple comfort or stress-relief.

Evidence-Based Benefits

Systematic reviews and randomized clinical trials within the last ten years have identified several notable benefits of foot reflexology, especially as an adjunct to mainstream healthcare. These include:

Significant, measurable reductions in pain levels for patients recovering from surgical procedures such as open cardiac surgery and coronary artery bypass grafts, with reflexology sessions correlated to improvements in resilience, coping, and overall wellbeing.
Meta-analyses have demonstrated marked improvements in depression, anxiety, and sleep quality, suggesting that reflexology may exert substantial psycho-emotional effects.
Reduced medication burden for patients undergoing ongoing medical care, lowering the need for analgesics and sometimes improving medication tolerability.
Improvements in quality of life for individuals undergoing haemodialysis or living with chronic health conditions, with better outcomes reported among reflexology as opposed to general foot or body massage.
Enhanced relaxation, circulation, and systemic balance, making it useful for those seeking complementary approaches to chronic conditions like migraines, fatigue, and digestive complaints.

Despite these promising results, governmental and expert reviews have noted that the certainty of evidence for physical function remains very low for some indications and further well-controlled studies are needed.

How Foot Reflexology Differs from Other Adjunct Therapies

While foot reflexology and foot massage both involve manipulation of the feet, their intent and outcomes are fundamentally different. Foot reflexology is more precisely connected to systemic health outcomes. It is considered a deeper therapy, used to promote wellness at the level of body systems rather than just musculoskeletal comfort. Check out more of the differences between foot reflexology and foot massage here .

Safe Application Guidelines

Safe and effective foot reflexology requires adopting evidence-based approaches and awareness of individual client needs.

Seek only certified reflexologists, preferably with medical or allied health training, who follow standardized pressure protocols and maintain client safety and comfort.
Sessions are typically 30–60 minutes, with the practitioner working through mapped zones across both feet. Pressure should be firm but never painful; discomfort can be a sign the technique is too intense or contraindicated for the individual.
Areas of localized pain, swelling, or injury should be avoided outright, and the reflexologist should always inquire about the client’s health history, recent medical procedures, or symptoms before commencing therapy.
Clinical settings, such as those in postoperative care or oncology, may integrate reflexology into broader pain-management or psychological support programs, with careful monitoring of outcomes and adjustment as needed.
Hygiene protocols must be strict, with foot washing and sanitization required before and after sessions.

Contraindications and Precautions

Reflexology, although generally safe, has important contraindications that must be respected to avoid adverse outcomes or delayed medical care:

Active infections (e.g., athlete’s foot, cellulitis), open wounds, burns, or severe eczema or psoriasis on the feet.
Recent fractures, foot or ankle surgery—wait for full healing before considering reflexology.
Unstable heart conditions, especially if the client has a pacemaker or active cardiac symptoms. ALWAYS consult with a cardiologist or or your GP before proceeding.
Deep vein thrombosis, severe varicose veins, internal bleeding, or any acute circulatory compromise.
Pregnancy during the first trimester or with complications—specialized pregnancy reflexologists may be appropriate otherwise.
Acute gastrointestinal symptoms (vomiting, diarrhea), contagious illnesses, or fever.
Localized swelling, inflammation, severe pain, excessive bruising, or fresh scar tissue (wait appropriate healing time).
Individuals under the influence of alcohol or recreational drugs should avoid reflexology.

Practitioners should screen for these conditions upfront, and clear client consent is a must before proceeding. Any adverse effects (e.g., increased pain, dizziness, heaviness of menstrual bleeding) should trigger immediate cessation and medical review.

Informed Use of Foot Reflexology

The clinical and research evidence from the past decade supports foot reflexology as an effective, non-invasive adjunct therapy for select populations. When performed by certified, experienced practitioners and appropriately screened for contraindications, it may offer significant pain relief, psychological balance, and improvements in quality of life for medical patients and healthy individuals alike.

The therapy stands apart from simple foot massage due to its focus on reflex zones and holistic benefits, and its application in clinical settings continues to expand as evidence accumulates.

All potential consumers should discuss reflexology with a trusted health professional and ensure their practitioner is aware of any health conditions or injuries before beginning.

The Take Home

Foot reflexology, when delivered by trained practitioners, is a safe, drug-free way to reduce stress, support pain relief, improve mood, and enhance wellbeing. It offers holistic benefits for many people but should be avoided in certain medical situations. Strict adherence to safety protocols and contraindication screening maximizes both its value and safety, making foot reflexology a respected partner in modern well-being and patient care. Always consult a healthcare provider before beginning therapy.

Do have pain, stress or anxiety? Perhaps you're just looking for a different way to relax? Give us a call.

At Movement for Life Physiotherapy, we have a fully qualified remedial massage therapist who is trained in a range of therapeutic techniques, including foot reflexology, who works with our clinical team to achieve outstanding results for you.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Artioli, D. P., Tavares, A. L. D. F., & Bertolini, G. R. F. (2021). Foot reflexology in painful conditions: systematic review. BrJP, 4(2), 145-151.
Barefoot Holistics. (2024, June 5). Foot Massage vs Reflexology: Which is Best? https://barefootholistics.com.au
Cai, D. C., Chen, C. Y., & Lo, T. Y. (2022). Foot Reflexology: Recent Research Trends and Prospects. Healthcare (Basel, Switzerland), 11(1), 9. https://doi.org/10.3390/healthcare11010009
Cirino, E (2024). Reflexology 101. Healthline, https://www.healthline.com/health/what-is-reflexology
Cleveland Clinic. (2022, August 29). Reflexology: What It Is and How It Works. https://health.clevelandclinic.org
Davila, M. (2025). Reflexology as a Complementary Therapy: A Critical Review Toward a Definition Based on Its Neurophysiological Action.
Department of Health, Australian Government. (2025). Natural Therapies Review 2024 – Reflexology evidence evaluation. Retrieved from https://www.health.gov.au/sites/default/files/2025-03/natural-therapies-review-2024-reflexology-evidence-evaluation.pdf health.gov.au
Healthland Spa. (2025, August 7). Foot Reflexology Massage Versus a Foot Massage. https://healthlandspa.com
Klaus, M., Kutschan, S., Männle, H., Hübner, J., & Dörfler, J. (2024). Reflexology in oncological treatment–a systematic review. BMC complementary medicine and therapies, 24(1), 32.
Northwich Foot Clinic. (2025, April 1). Who Should Avoid Reflexology? Contraindications & Guide. https://northwichfootclinic.co.uk/who-should-avoid-reflexology
Quinn, D, & Bence, S (2025). Foot Reflexology Chart: How it works, potential risks and benefits. https://www.healthline.com/health/foot-reflexology-chart
Senosy, A. M. K., Shady, R. H. A., Ahmed, Z. A., Aldeeb, A. A., Moustafa, M. S., & Hegazy, T. F. F. (2025). Effect of foot reflexology on relieving pain and improving resilience among patients undergoing coronary artery bypass graft. BMC nursing, 24(1), 1170. https://doi.org/10.1186/s12912-025-03860-w
Skills Competences Canada. (n.d.). Foot Reflexology Contraindications. https://skillscompetencescanada.com
Taheri Hatkehlouei, S. A., Sandanasamy, S., Yildirim, N., Karjalian, F., McFarlane, P., Farhadi, B., & Jaafari, B. (2024). Effects of reflexology on pain in patients with rheumatoid arthritis: A systematic review. Journal of Nursing Reports in Clinical Practice, 3(5), 469-477.
Wang, W. L., Hung, H. Y., Chen, Y. R., Chen, K. H., Yang, S. N., Chu, C. M., & Chan, Y. Y. (2020). Effect of foot reflexology intervention on depression, anxiety, and sleep quality in adults: A meta‐analysis and metaregression of randomized controlled trials. Evidence‐Based Complementary and Alternative Medicine, 2020(1), 2654353.
Yang, J. M., Li, Z. Q., Ye, H., Wu, Y. L., Long, Y., Zhong, Y. B., ... & Wang, M. Y. (2024). Effects of foot reflexology massage on pregnant women: a systematic review and meta-analysis of randomized controlled studies. Scientific Reports, 14(1), 1012.

Exercise for Stress and Anxiety

Wed, 01 Oct 2025 05:05:19 GMT

Regular physical activity is a core component of mental health care.

Get your free guide to Exercise for Stress and Anxiety here.

Stress and anxiety are highly prevalent mental health concerns in Australia, with significant impact on individual’s quality of life and overall health, and a substantial personal and national economic burden. Exercise and physiotherapy have emerged as important adjuncts in the management of these conditions, supported by a growing body of evidence demonstrating their efficacy in reducing symptoms and improving wellbeing.

Who gets it?

Recent data indicate that stress and anxiety remain common among Australian adults, with the COVID-19 pandemic exacerbating these issues. Young adults aged 16–24 years have the highest and fastest-rising prevalence of these conditions and the associated productivity losses and healthcare costs.

The 2020–22 Australian National Surveys of Mental Health and Wellbeing found that the 12-month prevalence of anxiety and mood disorders is highest in this age group, with a significant increase compared to previous years.

Young adults also experience greater severity and impairment, leading to more days out of role and higher indirect costs from lost productivity and early workforce exit.

Working-age adults (18–64 years) as a whole account for the majority of total economic costs, given their large representation in the workforce and the substantial productivity losses attributed to high-prevalence mental disorders, including anxiety and stress-related conditions. However, the most pronounced increases in prevalence and burden are concentrated among those aged 16–24 years, making this group the primary driver of recent increases in economic impact.

Lower income and socioeconomic status further amplify the burden within these age groups, as both prevalence and severity of psychological distress are higher among younger and lower-income Australians, compounding the overall economic impact.

How much is this costing us?

The economic cost of stress and anxiety on the Australian economy is substantial. According to large-scale analyses of workforce data, annual productivity losses alone are estimated at $5.9 billion AUD due to psychological distress among employees. High-prevalence mental disorders, including anxiety and stress-related conditions, incur additional direct healthcare costs of approximately $974 million AUD per year, and are associated with annual welfare payments of $12.9 billion AUD and income tax losses of $1.23 billion AUD.

Work-related stress claims are the most expensive form of workers’ compensation in Australia, primarily due to prolonged absence and complex medical care requirements.

Systematic reviews confirm that productivity-related losses constitute the majority (70–90%) of the total societal cost of work-related stress, with healthcare and medical costs making up the remainder.

Evidence for Exercise in Mental Health Management

Longitudinal studies show that Australians who meet physical activity guidelines report lower levels of depression, anxiety, and stress compared to those who do not, underscoring the public health relevance of physical activity in this population.

Multiple systematic reviews and meta-analyses confirm that physical activity interventions yield moderate reductions in anxiety and psychological distress across diverse adult populations, including those with diagnosed mental health disorders. Both aerobic and resistance exercise modalities are effective, with higher intensity regimens generally associated with greater symptom improvement.

Exercise exerts its anxiolytic (anxiety-relieving) effects through neurobiological mechanisms (e.g., enhanced neuroplasticity, anti-inflammatory effects) and behavioural pathways (e.g., improved self-regulation). Importantly, exercise is beneficial as both a stand-alone and adjunctive treatment, and its effects are observed in both clinical and non-clinical populations.

Role of Physiotherapy as Part of a Multidisciplinary Approach

Physiotherapists play a key role in the multidisciplinary management of stress and anxiety by prescribing individualized exercise programs, addressing barriers to physical activity, and supporting sustained engagement.

Their expertise in tailoring interventions to patient needs and comorbidities enhances adherence and optimizes outcomes.

Physiotherapy can be integrated with psychological and pharmacological treatments, providing a holistic approach that addresses both mental and physical health. Collaboration with other health professionals ensures comprehensive care, particularly for patients with complex presentations or chronic disease.

Take-home Message

Exercise and physiotherapy are evidence-based, cost-effective strategies for the treatment and management of stress and anxiety. Regular physical activity should be promoted as a core component of mental health care, with physiotherapists contributing essential expertise within multidisciplinary teams. Individualized, higher-intensity exercise regimens may confer greater benefits, but all forms of physical activity are valuable. Ongoing research is needed to refine protocols and maximize therapeutic impact, but current evidence strongly supports the integration of exercise and physiotherapy into routine mental health practice.

Are you struggling with stress and/or anxiety? Give us a call.

At Movement for Life Physiotherapy, we can assess your physical fitness and prescribe you with an evidence-based, tailored exercise program. With a clear management plan and support from our team, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Aylett, E., Small, N., & Bower, P. (2018). Exercise in the treatment of clinical anxiety in general practice - a systematic review and meta-analysis. BMC health services research, 18(1), 559. https://doi.org/10.1186/s12913-018-3313-5
Hassard, J., Teoh, K. R. H., Visockaite, G., Dewe, P., & Cox, T. (2018). The cost of work-related stress to society: A systematic review. Journal of occupational health psychology, 23(1), 1–17. https://doi.org/10.1037/ocp0000069
Hilton, M. F., Scuffham, P. A., Vecchio, N., & Whiteford, H. A. (2010). Using the interaction of mental health symptoms and treatment status to estimate lost employee productivity. The Australian and New Zealand journal of psychiatry, 44(2), 151–161. https://doi.org/10.3109/00048670903393605
Jayakody, K., Gunadasa, S., & Hosker, C. (2014). Exercise for anxiety disorders: systematic review. British journal of sports medicine, 48(3), 187–196. https://doi.org/10.1136/bjsports-2012-091287
Lee, Y. C., Chatterton, M. L., Magnus, A., Mohebbi, M., Le, L. K., & Mihalopoulos, C. (2017). Cost of high prevalence mental disorders: Findings from the 2007 Australian National Survey of Mental Health and Wellbeing. The Australian and New Zealand journal of psychiatry, 51(12), 1198–1211. https://doi.org/10.1177/0004867417710730
Moylan, S., Eyre, H. A., Maes, M., Baune, B. T., Jacka, F. N., & Berk, M. (2013). Exercising the worry away: how inflammation, oxidative and nitrogen stress mediates the beneficial effect of physical activity on anxiety disorder symptoms and behaviours. Neuroscience and biobehavioral reviews, 37(4), 573–584. https://doi.org/10.1016/j.neubiorev.2013.02.003
Ramos-Sanchez, C. P., Schuch, F. B., Seedat, S., Louw, Q. A., Stubbs, B., Rosenbaum, S., Firth, J., van Winkel, R., & Vancampfort, D. (2021). The anxiolytic effects of exercise for people with anxiety and related disorders: An update of the available meta-analytic evidence. Psychiatry research, 302, 114046. https://doi.org/10.1016/j.psychres.2021.114046
Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O'Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British journal of sports medicine, 57(18), 1203–1209. https://doi.org/10.1136/bjsports-2022-106195
Slade, T., Vescovi, J., Chapman, C., Teesson, M., Arya, V., Pirkis, J., Harris, M. G., Burgess, P. M., Santomauro, D., O'Dean, S., Tapp, C., & Sunderland, M. (2025). The epidemiology of mental and substance use disorders in Australia 2020-22: Prevalence, socio-demographic correlates, severity, impairment and changes over time. The Australian and New Zealand journal of psychiatry, 59(6), 510–521. https://doi.org/10.1177/00048674241275892
Smith, P. J., & Merwin, R. M. (2021). The Role of Exercise in Management of Mental Health Disorders: An Integrative Review. Annual review of medicine, 72, 45–62. https://doi.org/10.1146/annurev-med-060619-022943
Stubbs, B., Vancampfort, D., Rosenbaum, S., Firth, J., Cosco, T., Veronese, N., Salum, G. A., & Schuch, F. B. (2017). An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: A meta-analysis. Psychiatry research, 249, 102–108. https://doi.org/10.1016/j.psychres.2016.12.020
Teesson, M., Whiteford, H., Bower, M., Smout, S., Burgess, P., Harris, M. G., Pirkis, J., Diminic, S., Baillie, A., Slade, T., & Chapman, C. (2025). Policy implications of the 2020-22 Australian study of mental health and wellbeing. The Australian and New Zealand journal of psychiatry, 59(6), 485–492. https://doi.org/10.1177/00048674241292961
Thomas, A. J., Reavley, N., Wickramaarachi, T., Sweeny, K., Erskine, H., Husin, H. M., Azzopardi, P., Sawyer, S. M., & Scott, N. (2025). Return on investment from interventions to prevent common mental disorders among adolescents in Australia: A modelling study. The Australian and New Zealand journal of psychiatry, 48674251370449. Advance online publication. https://doi.org/10.1177/00048674251370449
Zhao, W., Vandelanotte, C., Khalesi, S., Alley, S. J., Williams, S. L., Thwaite, T. L., Fenning, A. S., Stanton, R., & To, Q. G. (2022). Depression, anxiety, stress, and physical activity of Australian adults during COVID-19: A combined longitudinal and repeated cross-sectional study. Frontiers in psychology, 13, 962962. https://doi.org/10.3389/fpsyg.2022.962962

Lumbar Spondylolysis

Tue, 30 Sep 2025 11:21:12 GMT

Catch low back pain in active adolescents early for best results and earlier return to sport.

Try these low impact exercises for mild low back pain.

Lumbar spondylolysis is a stress fracture of the pars interarticularis (part of the lumbar vertebra), most commonly affecting adolescent athletes who participate in sports involving repetitive lumbar extension and rotation. It is a frequent cause of low back pain in this population and is typically managed conservatively, with physiotherapy playing a central role in rehabilitation and return to activity.

Anatomy 101

The pars interarticularis is a segment of bone located between the superior and inferior articular processes of the vertebra. In the lumbar spine, spondylolysis most often affects the L5 vertebra, followed by L4. The defect may be unilateral or bilateral and can compromise spinal stability, potentially progressing to spondylolisthesis if both sides are involved. The lumbar spine is subject to significant mechanical stress during activities involving extension, flexion, and rotation, making the pars interarticularis vulnerable to fatigue fractures, especially in growing adolescents engaged in high-impact sports.

Who gets it?

Spondylolysis is the most frequent diagnosis in adolescent athletes presenting with low back pain, with a higher prevalence in sports such as cricket, gymnastics, football, weightlifting, and diving.

The majority of cases occur during the adolescent growth spurt, often coinciding with a concomitant increase in training load.

Progression to spondylolisthesis is uncommon but more likely in those with bilateral defects.

Diagnosing Spondylosis

Patients typically present with axial low back pain of insidious or acute onset, worsened by activity and relieved by rest. Physical examination findings are non-specific, and pain may be elicited with lumbar extension. Diagnosis is confirmed radiographically; standing anteroposterior and lateral lumbar spine X-rays are first-line, while oblique views are not recommended due to increased radiation and limited diagnostic yield. MRI is useful for detecting early stress reactions and bone marrow edema before a fracture line develops, while CT provides detailed visualization of bony defects and assessment of healing.

What imaging is required

Initial evaluation should include standing AP and lateral lumbar spine X-rays . MRI is preferred for early or occult lesions and for evaluating bone marrow edema, while CT is reserved for confirming bony defects and monitoring healing.

Treatment

Conservative management is the first-line treatment for lumbar spondylolysis. The American College of Sports Medicine recommends activity modification, including cessation of aggravating sports, as the cornerstone of initial therapy. Bracing with a thoracolumbosacral orthosis may be considered, though its benefit is debated; outcomes are similar with or without bracing.

Physiotherapy should focus on lumbar segmental stabilization exercises (LSSE).

The most recent meta-analysis of randomized controlled trials demonstrates that lumbar segmental stabilization exercises (LSSE) as a single intervention significantly improve disability in patients with spondylolysis and spondylolisthesis. LSSE specifically target the deep stabilizing muscles of the lumbar spine, such as the transversus abdominis and lumbar multifidus, to enhance intersegmental control and dynamic stability.

General core strengthening and other exercise-based protocols are also effective for most patients. Core strengthening, combined with stretching, functional exercise, and gradual reintroduction of activity are essential components of rehabilitation. The choice of protocol should be individualized, considering patient-specific factors, adherence, and therapist expertise.

Can I get an injection? What about surgery?

Steroid injections are reserved for persistent pain refractory to conservative measures. Surgical intervention is rarely required and is typically reserved for high-grade spondylolisthesis or neurological compromise.

How long’s it going to take?

Most patients experience symptom resolution and return to normal activities and sport within 2-4 months of conservative management, with bony healing rates exceeding 90% in early-stage lesions. Recurrence rates are notable but do not preclude eventual healing. Long-term prognosis is excellent, with the vast majority regaining full function and activity.

Take Home

Lumbar spondylolysis in adolescent athletes is best managed with early diagnosis, activity modification, and targeted physiotherapy. Most cases heal with conservative treatment, and lumbar segmental stabilization exercises are particularly effective for improving disability. Imaging should be judiciously selected to confirm diagnosis and monitor healing. Prompt, evidence-based management leads to excellent outcomes and safe return to sport.

Have you or your child got back pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and help diagnose the cause of your back pain and let you know if you have spondylolysis, non-specific low back pain, or if something else is going on.. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Aoki, Y., Takahashi, H., Nakajima, A., Kubota, G., Watanabe, A., Nakajima, T., Eguchi, Y., Orita, S., Fukuchi, H., Yanagawa, N., Nakagawa, K., & Ohtori, S. (2020). Prevalence of lumbar spondylolysis and spondylolisthesis in patients with degenerative spinal disease. Scientific reports, 10(1), 6739. https://doi.org/10.1038/s41598-020-63784-0
Berger, R. G., & Doyle, S. M. (2019). Spondylolysis 2019 update. Current opinion in pediatrics, 31(1), 61–68. https://doi.org/10.1097/MOP.0000000000000706
Choi, J. H., Ochoa, J. K., Lubinus, A., Timon, S., Lee, Y. P., & Bhatia, N. N. (2022). Management of lumbar spondylolysis in the adolescent athlete: a review of over 200 cases. The spine journal : official journal of the North American Spine Society, 22(10), 1628–1633. https://doi.org/10.1016/j.spinee.2022.04.011
Fredericson, Michael & Jennings, Fabio & Beaulieu, Christopher. (2006). Stress Fractures in Athletes. Topics in magnetic resonance imaging : TMRI. 17. 309-25. 10.1097/RMR.0b013e3180421c8c.
Gagnet, P., Kern, K., Andrews, K., Elgafy, H., & Ebraheim, N. (2018). Spondylolysis and spondylolisthesis: A review of the literature. Journal of orthopaedics, 15(2), 404-407.
Helenius, I., Virkki, E., Toomela, T., Studer, D., Gehrchen, M., & Ahonen, M. (2025). An Acta Orthopaedica educational article: Treatment of pediatric spondylolysis and spondylolisthesis. Acta orthopaedica, 96, 80–86. https://doi.org/10.2340/17453674.2024.42450
Kalichman, L., Kim, D. H., Li, L., Guermazi, A., Berkin, V., & Hunter, D. J.. (2009). Spondylolysis and Spondylolisthesis. Spine, 34(2), 199–205. https://doi.org/10.1097/brs.0b013e31818edcfd
Leone, A., Cianfoni, A., Cerase, A., Magarelli, N., & Bonomo, L. (2011). Lumbar spondylolysis: a review. Skeletal radiology, 40(6), 683–700. https://doi.org/10.1007/s00256-010-0942-0
Li, N., Amarasinghe, S., Boudreaux, K., Fakhre, W., Sherman, W., & Kaye, A. D. (2022). Spondylolysis. Orthopedic Reviews, 14(3).
Lin, L. H., Lin, T. Y., Chang, K. V., Wu, W. T., & Özçakar, L. (2024). Effectiveness of Lumbar Segmental Stabilization Exercises in Managing Disability and Pain Intensity Among Patients With Lumbar Spondylolysis and Spondylolisthesis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Spine, 49(21), 1512–1520. https://doi.org/10.1097/BRS.0000000000004989
Massachusetts General Brigham Pediatric Sports Medicine. Rehabilitation Guidelines for Conservative Management of Spondylolysis/Spondylolisthesis in the Young Athlete. https://www.massgeneral.org/assets/mgh/pdf/orthopaedics/sports-medicine/physical-therapy/pediatric-conservative-management-of-spondylolysis-and-spondylolisthesis.pdf
Sakai, T., Tezuka, F., Yamashita, K., Takata, Y., Higashino, K., Nagamachi, A., & Sairyo, K. (2017). Conservative Treatment for Bony Healing in Pediatric Lumbar Spondylolysis. Spine, 42(12), E716–E720. https://doi.org/10.1097/BRS.0000000000001931
Selected Issues for the Adolescent Athlete and the Team Physician: A Consensus Statement. Medicine & Science in Sports & Exercise 40(11):p 1997-2012, November 2008. | DOI: 10.1249/MSS.0b013e31818acdcb

To see more articles on Women's Health or Persistent Pain, head back to the Treatment Room and select the area you wish to explore further.

Chronic Pelvic Pain and Endometriosis

Tue, 30 Sep 2025 06:37:27 GMT

Posterior elbow pain is a common symptom of bone stress injury.

Try these low impact exercises for mild pelvic pain.

Chronic pelvic pain (CPP) is a persistent pain condition lasting at least six months, often associated with endometriosis, and significantly impairs quality of life and function. Endometriosis is a chronic, estrogen-dependent inflammatory disease characterized by endometrial-like tissue outside the uterus, with pain as the predominant symptom. Physiotherapy is increasingly recognized as a key component of multidisciplinary management for these patients.

Anatomy 101

The female pelvis contains reproductive, urinary, and digestive organs, supported by a complex musculoskeletal system. Key anatomical structures involved in chronic pelvic pain include the uterus, ovaries, fallopian tubes, bladder, rectum, and pelvic floor muscles.

Endometriosis occurs when endometrial-like tissue grows outside the uterus, commonly on the peritoneum, ovaries, or pelvic ligaments.

These implants bleed cyclically, causing inflammation, scarring, and adhesions. Over time, this can irritate peripheral nerves, contribute to myofascial trigger points, and disrupt pelvic biomechanics. The pelvic floor muscles often become hypertonic, leading to pain with intercourse, bladder urgency, or bowel dysfunction. Understanding both visceral and musculoskeletal contributors is essential for physiotherapists, who must integrate anatomical, neurological, and functional perspectives when assessing and treating women with chronic pelvic pain and endometriosis.

Who gets it?

Endometriosis affects approximately 1 in 9 women of reproductive age in Australia and an estimated 10% globally. It is commonly diagnosed in women aged 20–40 years but may present earlier in adolescence. Chronic pelvic pain, including pain from endometriosis, is a major contributor to reduced participation in work, education, and exercise.

Many women experience diagnostic delays, with symptoms often dismissed or attributed to “normal period pain.”

The high prevalence and impact highlight the need for timely diagnosis and a multidisciplinary management approach, with physiotherapy playing a central role.

Diagnosing Chronic Pelvic Pain and Endometriosis

Diagnosing endometriosis can be challenging due to the variability of symptoms and overlap with other pelvic pain conditions. Common symptoms include dysmenorrhea (painful periods), chronic pelvic pain, dyspareunia (painful intercourse), bowel or bladder pain, and infertility.

Clinical assessment should include a thorough history, pain mapping, and a musculoskeletal evaluation to assess pelvic floor function, posture, and movement patterns. On examination, physiotherapists may identify pelvic floor muscle overactivity, abdominal wall tension, or postural compensations that contribute to pain. While a definitive diagnosis of endometriosis requires laparoscopic surgery with histological confirmation, physiotherapists are often among the first health professionals to identify red flags or patterns of persistent pelvic pain. Collaborative referral to gynaecology and inclusion in a multidisciplinary care team ensures patients receive comprehensive support across medical, surgical, and conservative management pathways.

Do I need a scan?

Imaging is useful but not always definitive for endometriosis. Transvaginal or transabdominal ultrasound may detect ovarian endometriomas or deep infiltrating disease, but small peritoneal lesions are often missed. MRI can help map disease extent, particularly in complex cases involving bowel or bladder.

Importantly, normal imaging does not rule out endometriosis.

Physiotherapists should be aware of imaging limitations and focus on functional and musculoskeletal assessment, while encouraging referral for further investigation when symptoms are severe or unresponsive to conservative management. Imaging supports, but does not replace, clinical evaluation and multidisciplinary input.

Treatment

Effective treatment for chronic pelvic pain and endometriosis is multimodal, involving medical, surgical, and allied health input. For physiotherapists, understanding the complex interaction between musculoskeletal dysfunction, visceral pain, and central sensitisation is crucial in supporting effective management.

Endometriosis-related pain is not just limited to menstruation—it can impact bladder, bowel, and sexual function, as well as daily movement and exercise. Physiotherapy focuses on restoring pelvic floor and musculoskeletal function, improving movement, and reducing central sensitisation. Manual therapy, myofascial release, and down-training techniques can help reduce pelvic floor muscle overactivity. Education on pain science is crucial in reducing fear-avoidance behaviours and empowering women to re-engage with activity.

Exercise therapy, including gentle strengthening, stretching, and paced aerobic activity, supports improved mobility and pain modulation.

Adjunctive strategies include relaxation, mindfulness, and breathing exercises to regulate the autonomic nervous system. Physiotherapists also play a role in bladder and bowel retraining, sexual health rehabilitation, and lifestyle modification. Collaboration with gynaecologists (for hormonal or surgical interventions), psychologists (for coping and mental health), and dietitians (for gut health and inflammation) is often necessary. The goal is not only to reduce pain but to enhance participation, function, and quality of life.

How long’s it going to take?

The prognosis of chronic pelvic pain and endometriosis varies widely. Symptoms may persist for years, especially if diagnosis and treatment are delayed. Surgical excision can reduce disease burden, but recurrence is common. Physiotherapy helps women manage ongoing symptoms, improve function, and build resilience, even when pain cannot be fully eliminated.

Progress often requires consistent treatment and gradual reintroduction of physical activity. While complete resolution is rare, many women experience meaningful improvements in pain, movement, and daily life with early, multidisciplinary care.

The Take Home

Chronic pelvic pain and endometriosis are complex, multifactorial conditions that significantly impact women’s lives. Diagnosis can be delayed, and imaging has limitations, but physiotherapists play an essential role in early recognition, referral, and conservative management. Through pelvic floor rehabilitation, pain education, exercise, and multidisciplinary collaboration, physiotherapy helps restore function and improve quality of life. While there may not be a quick fix, a comprehensive, supportive approach empowers women to manage symptoms, re-engage in meaningful activities, and live well despite the challenges of chronic pelvic pain.

Looking for more information? Click here for more on Pelvic Floor Health.

Got persistent pelvic pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and help diagnose the cause of your pelvic pain and provide you with tailored exercises and relevant manual therapy. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

As-Sanie S, Mackenzie SC, Morrison L, et al. (2025). Endometriosis: A Review. JAMA, 334(1):64–78. doi:10.1001/jama.2025.2975
Ball, E., & Khan, K. S. (2020). Recent advances in understanding and managing chronic pelvic pain in women with special consideration to endometriosis. F1000Research, 9, F1000 Faculty Rev-83. https://doi.org/10.12688/f1000research.20750.1
Berghmans B. (2018). Physiotherapy for pelvic pain and female sexual dysfunction: an untapped resource. International urogynecology journal, 29(5), 631–638. https://doi.org/10.1007/s00192-017-3536-8
Can, G., Amorim das Virgens, I. P., Fehér, B., Orbán, E. P., Fehérvári, P., Bánhidy, F., Hegyi, P., Mayer, Á. A., & Ács, N. (2025). Physiotherapy for endometriosis-associated pelvic pain: A systematic review and meta-analysis. Pain medicine (Malden, Mass.), pnaf083. Advance online publication. https://doi.org/10.1093/pm/pnaf083
Chronic Pelvic Pain: ACOG Practice Bulletin Summary, Number 218. (2020). Obstetrics and gynecology, 135(3), 744–746. https://doi.org/10.1097/AOG.0000000000003717
Lamvu G, Carrillo J, Ouyang C, Rapkin A. (2021). Chronic Pelvic Pain in Women: A Review. JAMA. 325(23):2381–2391. doi:10.1001/jama.2021.2631
Meisenheimer, E. S., & Carnevale, A. M. (2025). Chronic Pelvic Pain in Women: Evaluation and Treatment. American family physician, 111(3), 218–229.
Speer, L. M., Mushkbar, S., & Erbele, T. (2016). Chronic Pelvic Pain in Women. American family physician, 93(5), 380–387.
Vincent, K., & Evans, E. (2021). An update on the management of chronic pelvic pain in women. Anaesthesia, 76 Suppl 4, 96–107. https://doi.org/10.1111/anae.15421
Wójcik, M., Szczepaniak, R., & Placek, K. (2022). Physiotherapy Management in Endometriosis. International journal of environmental research and public health, 19(23), 16148. https://doi.org/10.3390/ijerph192316148
Zondervan KT, Becker CM, and Missmer SA. (2020). Endometriosis. The New England Journal of Medicine, 382(13): 1244-1256. DOI: 10.1056/NEJMra1810764

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Olecranon Stress Fracture

Tue, 30 Sep 2025 01:49:45 GMT

Posterior elbow pain is a common symptom of bone stress injury.

Download our patient guide for Olecranon Stress Fractures here.

Olecranon stress fractures are rare overuse injuries of the proximal ulna, most commonly seen in athletes engaged in repetitive elbow extension activities. Early recognition and appropriate management are essential to prevent progression to complete fracture and to facilitate safe return to sport.

Anatomy 101

The olecranon is the proximal bony prominence of the ulna, forming the tip of the elbow and serving as the insertion site for the triceps brachii . It is subject to significant tensile and compressive forces during elbow extension, especially in throwing and weight-bearing activities. The articular surface articulates with the trochlea of the humerus, while the posterior cortex is exposed to repetitive microtrauma in athletes. The surrounding soft tissues, including the ulnar collateral ligament and the triceps tendon, play a role in both stability and the pathogenesis of stress injuries, with valgus extension overload and triceps traction implicated in fracture development.

Who gets it?

Olecranon stress fractures predominantly affect adolescent and young adult athletes, especially baseball pitchers, javelin throwers, gymnasts, and weightlifters.

The incidence is increasing with greater sports participation, and these injuries account for approximately 5% of elbow disorders in throwing athletes.

Diagnosing Olecranon Stress fracture

Diagnosis relies on a combination of clinical history and examination. Patients typically present with insidious onset of posterior elbow pain, worsened by activity and relieved by rest. Localized tenderness over the olecranon is common, and swelling may be present. Differential diagnosis includes tendinopathy, apophysitis, and other bone stress injuries. Early radiographs may be normal; thus, a high index of suspicion is required in at-risk athletes. MRI is the preferred modality for definitive diagnosis, revealing marrow edema and fracture lines, while CT can help classify fracture type and guide management.

Do I need a Scan?

Initial evaluation should include plain radiographs, though sensitivity is low in early stress injury. MRI is the gold standard for diagnosis and staging, while CT is useful for surgical planning in complex or displaced fractures.

Treatment

The latest evidence indicates that progressive, individualized physiotherapy protocols are effective in accelerating recovery and return to sport for athletes with olecranon stress fractures.

But there is no universally accepted protocol specific to this injury. The International Delphi Consensus on Bone Stress Injuries in Athletes recommends a multifactorial approach: initial rest and activity modification, followed by a staged rehabilitation program emphasizing pain-free range of motion, gradual strengthening of the triceps and forearm musculature, and correction of biomechanical risk factors such as throwing mechanics or training errors.

For nonoperative cases, early mobilization within pain limits is encouraged to prevent stiffness, with progressive loading introduced as symptoms resolve. Activity modification and rest are the first-line treatments for non-displaced or minimally displaced olecranon stress fractures, with immobilization considered for pain control. Physiotherapy focuses on maintaining range of motion, gradual strengthening, and correction of biomechanical risk factors.

Return-to-sport decisions should be based on clinical assessment, functional testing, and imaging confirmation of healing, rather than fixed timelines. Multidisciplinary consensus emphasizes the importance of psychological readiness and integrated care to optimize outcomes.

While exercise-based rehabilitation is critical, there is insufficient evidence to support adjunctive modalities such as cryotherapy beyond short-term analgesia, and their use should be limited.

Overall, individualized, progressive rehabilitation—coordinated with medical and surgical management—remains the cornerstone for safe and effective return to sport in athletes with olecranon stress fractures.

Will I need surgery?

Surgical intervention, typically tension band wiring or screw fixation, is reserved for displaced fractures, nonunion, or high-level athletes requiring rapid return to play. Protocols typically begin with immobilization for 2–4 weeks, then transition to active and passive range of motion exercises, followed by strengthening and sport-specific retraining once radiographic healing is confirmed. Rehabilitation should be individualized, emphasizing progressive loading and sport-specific retraining once pain resolves and radiographic healing is confirmed.

How long does it take?

Most non-displaced olecranon stress fractures heal uneventfully with conservative management, with return to sport typically expected within 3–6 months. Surgical cases may require longer rehabilitation, but outcomes are generally favourable.

Comorbidities, particularly multimorbidity (the presence of two or more chronic conditions), are associated with slower and less complete rehabilitation outcomes for patients with olecranon stress fractures. Patients with multimorbidity experience a significantly slower reduction in disability and functional recovery following injury compared to those with none or only one comorbidity.

Specific comorbidities such as osteogenesis imperfecta can increase the risk of recurrent fractures and may necessitate tailored rehabilitation protocols, as seen in paediatric populations.

Comprehensive assessment and individualized rehabilitation planning are essential for patients with significant comorbidities to optimize recovery trajectories and minimize complications.

Take Home Message:

Olecranon stress fractures should be considered in athletes with posterior elbow pain and a history of repetitive extension loading. Early diagnosis and appropriate management—primarily rest, activity modification, and targeted rehabilitation—are key to optimal recovery and prevention of complications.

Got elbow pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your elbow pain and let you know whether you have a olecranon stress fracture, early stress response, nerve entrapment, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Davie, G., Samaranayaka, A., & Derrett, S. (2018). The role of pre-existing comorbidity on the rate of recovery following injury: A longitudinal cohort study. PloS one, 13(2), e0193019. https://doi.org/10.1371/journal.pone.0193019
Debopadhaya, S., & Marmor, M. T. (2023). Frailty and comorbidity predict 30 day postoperative outcomes, independent of anatomical site of fracture. Archives of orthopaedic and trauma surgery, 143(8), 4697–4704. https://doi.org/10.1007/s00402-023-04764-7
Furushima, K., Itoh, Y., Iwabu, S., Yamamoto, Y., Koga, R., & Shimizu, M. (2014). Classification of Olecranon Stress Fractures in Baseball Players. The American journal of sports medicine, 42(6), 1343–1351. https://doi.org/10.1177/0363546514528099
Fujioka, H., Tsunemi, K., Takagi, Y., & Tanaka, J. (2012). Treatment of stress fracture of the olecranon in throwing athletes with internal fixation through a small incision. Sports medicine, arthroscopy, rehabilitation, therapy & technology : SMARTT, 4(1), 49. https://doi.org/10.1186/1758-2555-4-49
Greif, D. N., Emerson, C. P., Allegra, P., Shallop, B. J., & Kaplan, L. D. (2020). Olecranon Stress Fracture. Clinics in sports medicine, 39(3), 575–588. https://doi.org/10.1016/j.csm.2020.02.005
Jack, R.A., Dodson, C.C. (2021). Stress Fractures in Sport: Elbow. Fractures in Sport. Springer, Cham. https://doi.org/10.1007/978-3-030-72036-0_21
McBride, A. P., Brais, G., Wood, T., Ek, E. T. & Hoy, G. Stress reactions and fractures around the elbow in athletes. (2021).
Nuber, G. W., & Diment, M. T. (1992). Olecranon stress fractures in throwers. A report of two cases and a review of the literature. Clinical orthopaedics and related research, (278), 58–61.
Onay, T., Çelen, Z. E., Öncül, S., & Abul, M. S. (2023). Long-term Functional Consequences of Surgically Treated Pediatric and Adolescent Olecranon Fractures: Does the Presence of Associated Fractures and Surgical Procedure Affect the Results?. Journal of pediatric orthopedics, 43(3), 135–142. https://doi.org/10.1097/BPO.0000000000002313
Rao, P. S., Rao, S. K., & Navadgi, B. C. (2001). Olecranon stress fracture in a weight lifter: a case report. British journal of sports medicine, 35(1), 72–73. https://doi.org/10.1136/bjsm.35.1.72
Schroeder, J. D., Trigg, S. D., & Capo Dosal, G. E. (2024). Bone Stress Injuries: Diagnosis and Management. American family physician, 110(6), 592–600.
Smith, S. R., Patel, N. K., White, A. E., Hadley, C. J., & Dodson, C. C. (2018). Stress Fractures of the Elbow in the Throwing Athlete: A Systematic Review. Orthopaedic journal of sports medicine, 6(10), 2325967118799262. https://doi.org/10.1177/2325967118799262
Zaremski, J., L., Pazik, M., Moser, M. W., Horodyski, M. (2022). Olecranon Stress Fracture Management Challenges in a High School Baseball Pitcher: A Case Report and Review of the Literature. Current Sports Medicine Reports 21(6), 171-173. DOI: 10.1249/JSR.0000000000000962

Lower Crossed Syndrome

Fri, 26 Sep 2025 06:18:24 GMT

Lower crossed syndrome is the result of muscle strength imbalances in the low back, abdominal and pelvic regions.

Try these low impact exercises for lower crossed syndrome.

Lower Crossed Syndrome (LCS), or Unterkreuz syndrome , is a common postural imbalance that results from muscular tightness and weakness around the pelvis, hips, and lower back. It typically develops due to prolonged sitting, poor movement habits, or repetitive strain. The condition creates an altered pelvic tilt and an exaggerated spinal curvatures (thoracic and lumbar), contributing to back pain, hip dysfunction, and reduced movement efficiency. Physiotherapists play a key role in identifying and correcting these muscular imbalances through targeted exercise, education, and lifestyle modification, making LCS a treatable condition with the right approach.

Anatomy 101

Lower Crossed Syndrome is characterised by predictable muscle imbalances . The tight (facilitated) muscles typically include the hip flexors (iliopsoas, rectus femoris) and lumbar erector spinae. These work in opposition to the weak (inhibited) muscles, namely the gluteus maximus and medius, and the abdominal core stabilisers (transversus abdominis, rectus abdominis).

This imbalance results in an altered pelvic tilt, impacting the normal lumbar lordosis and thoracic kyphosis.

Over time, altered pelvic and spinal mechanics place excess strain on the lumbar spine, sacroiliac joints, and hips. These changes can impair gait, reduce functional strength, and increase the risk of chronic low back pain. Understanding the underlying anatomy helps physiotherapists design corrective interventions that restore muscular balance, improve posture, and optimise biomechanics in daily activity and sport.

Who gets it?

LCS is increasingly prevalent in modern societies, largely due to sedentary lifestyles and prolonged sitting at work. Office workers, professional drivers, and students are particularly susceptible. Athletes in sports requiring repetitive hip flexion, such as cycling or running, may also develop this pattern. It can affect all age groups, but adults between 20–50 years are most commonly diagnosed. With rising rates of sedentary behaviour worldwide, physiotherapists are seeing more patients presenting with postural syndromes such as LCS, highlighting the importance of early recognition and prevention strategies.

Diagnosing Lower Crossed Syndrome

Diagnosis of Lower Crossed Syndrome begins with a thorough postural and movement assessment. Physiotherapists observe for changes in pelvic tilt, lumbar lordosis, and compensatory thoracic changes.

Functional testing may reveal reduced hip extension, weak core stability, and over-reliance on lumbar extensors during movement.

Key muscle testing often identifies shortened iliopsoas and rectus femoris, alongside inhibited gluteals and abdominals. Patients often present with non-specific low back pain, hip discomfort, or feelings of stiffness in the lumbar region. Gait and squat analysis are particularly useful, as compensatory mechanics often become obvious during dynamic tasks.

It is important to distinguish between the different subtypes of LCS:

Type A – Also called posterior pelvic crossed syndrome, is associated with an increase in both the lumbar lordosis and thoracis kyphosis. It is characterized by tightness in the hip flexors, an anterior tilt of the pelvis, slight knee flexion in standing, and reduced quality of breathing.

Type B – Also called the anterior pelvic crossed syndrome, is associated with a reduction in the lumbar lordosis and an increase in thoracic kyphosis. It is characterized by tightness and weakness in the abdominals, posterior tilt of the pelvis, forward head posture, and knee hyperextension.

Differential diagnosis is important to rule out structural spinal pathology, disc issues, or hip joint disease. A physiotherapy-led assessment not only identifies the syndrome but also establishes which specific muscles require lengthening, strengthening, or neuromuscular retraining for an individualised rehabilitation plan.

Do I need a scan?

Lower Crossed Syndrome is a functional, not structural, diagnosis. As such, imaging is generally not required . Plain X-rays or MRI may occasionally be ordered if clinicians suspect underlying pathology such as disc herniation, spondylolisthesis, or hip joint disease contributing to symptoms. However, in most cases, a detailed physiotherapy assessment is sufficient. Imaging should only be used to rule out red flags or confirm co-existing musculoskeletal conditions. The emphasis remains on clinical evaluation, postural observation, and functional testing rather than reliance on radiology.

Treatment

Physiotherapy management of Lower Crossed Syndrome focuses on restoring muscular balance and improving posture. Treatment usually includes:

Stretching and mobility: Lengthening tight hip flexors (iliopsoas, rectus femoris) and lumbar erectors using targeted stretches and mobility drills.
Strengthening: Activating and strengthening weak gluteals and abdominal stabilisers through exercises such as bridges, clamshells, dead bugs, and planks.
Postural re-education: Teaching pelvic control and neutral spine positioning in sitting, standing, and functional movements.
Movement retraining: Correcting faulty squat, lifting, and gait mechanics to reduce compensatory loading on the lumbar spine.
Lifestyle modification: Ergonomic advice for desk setup, regular movement breaks, and integration of standing or walking into daily routines.
Manual therapy: Techniques such as soft tissue release or joint mobilisation may be used as adjuncts to reduce pain and improve mobility.

A progressive, individualised rehabilitation program combining these elements typically achieves the best outcomes. Physiotherapists also focus on patient education, empowering individuals to self-manage and prevent recurrence.

How long’s it going to take?

With consistent physiotherapy treatment, many patients experience symptom improvement within 6–8 weeks.

Full correction of postural habits and muscular imbalances may take 3–6 months, depending on severity and adherence.

The prognosis is generally excellent, provided patients engage in regular exercises and lifestyle changes. If left untreated, LCS can contribute to chronic low back pain, hip dysfunction, or compensatory injuries in the knees and upper spine. Long-term resolution relies on both targeted rehabilitation and behavioural modification.

The Take Home

Lower Crossed Syndrome is a common postural imbalance driven by modern sedentary lifestyles. Physiotherapists can identify and correct the muscular imbalances at its core through stretching, strengthening, postural retraining, and education. While it may not resolve overnight, consistent adherence to rehabilitation programs leads to excellent outcomes. Early recognition and proactive management are key to preventing chronic pain and maintaining healthy movement. If you notice poor posture, low back discomfort, or tight hips, seeking physiotherapy advice can help restore balance and function.

Got low back and hip pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your back and hip pain and let you know whether you have lower crossed syndrome, lumbar osteoarthritis, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Delitto, A., George, S. Z., Van Dillen, L., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., Godges, J. J., & Orthopaedic Section of the American Physical Therapy Association (2012). Low back pain. The Journal of orthopaedic and sports physical therapy, 42(4), A1–A57. https://doi.org/10.2519/jospt.2012.42.4.A1
Harris J. D. (2022). Editorial Commentary: The Pelvis is the Lowest Vertebral Level: Diagnostic Approach to Hip-Spine Syndrome. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 38(10), 2939–2941. https://doi.org/10.1016/j.arthro.2022.08.009
Mehta, T. B., & Sharma, A. Treatment Strategies for Lower Cross Syndrome: A Systematic Review. International journal of health sciences, 6(S4), 11309-11316.
Mehta, T. B., & Sharma, A. (2024). Lower cross syndrome: specific treatment protocol versus generalized treatment protocol. A randomized single-blinded trial. Folia Medica, 66(5), 662-672.
Niroomand, T., Rabiei, M., & Mohammadi, B. (2023). Investigating the Effects Janda's and Sahrmann's Correcting Exercise Approaches on Trunk Muscles Function in Young Girls with Lower Crossed Syndrome. Journal of Advanced Sport Technology, 7(3), 48-58.

Upper Crossed Syndrome

Thu, 18 Sep 2025 08:50:35 GMT

As screen time increases, so to is the incidence of Upper Crossed Syndrome. Are you at risk?

Try these low impact exercises for upper crossed syndrome.

Upper Crossed Syndrome (UCS) is a postural imbalance that arises from muscle weakness and tightness in the upper body. The term "Upper Crossed" refers to the pattern of muscle tightness and weakness that forms an "X" shape across the upper body. UCS typically develops from prolonged poor posture, especially in people who spend long hours sitting at desks or looking at screens, leading to a forward-head posture, rounded shoulders, and often neck or upper back discomfort . While not life-threatening, UCS can significantly impact daily function, contributing to pain, stiffness, and reduced movement efficiency if left untreated. Fortunately, with proper diagnosis and management, it is reversible.

Anatomy 101

UCS occurs due to a predictable pattern of muscular imbalance across the upper body. The syndrome involves tightness in the upper trapezius, levator scapulae, and pectoralis major/minor, crossing with weakness in the deep cervical flexors, lower trapezius, and serratus anterior.

This “crossed” pattern results in a forward head posture, elevated and protracted (rounded) shoulders, and thoracic kyphosis.

The imbalance alters normal joint mechanics, especially around the cervical spine, scapula, and shoulder girdle. Over time, this dysfunctional alignment stresses soft tissues and joints, leading to headaches, neck pain, restricted shoulder mobility, and sometimes nerve irritation. Understanding this anatomical interplay is essential for identifying the condition and targeting effective interventions.

Who gets it?

UCS is common in modern populations, particularly among office workers, students, and individuals with sedentary lifestyles. It is also prevalent in athletes who emphasize pushing movements, such as swimmers or weightlifters, without balancing posterior chain strength. The condition affects both men and women, though lifestyle and occupation are stronger determinants than age or sex. Increasing screen time, working remotely (ie. from home) and reduced physical activity have contributed to a rising incidence of UCS, making it one of the most frequently encountered postural syndromes in physiotherapy clinics today.

Diagnosis

Diagnosis of UCS is primarily clinical, based on observation and physical assessment. Postural analysis typically reveals a forward head, rounded shoulders, and increased thoracic kyphosis. On examination, shortened and overactive muscles (upper trapezius, levator scapulae, pectorals) contrast with inhibited and weak muscles (deep neck flexors, lower trapezius, serratus anterior).

Functional movement tests such as the cervical flexion test or scapular stability assessments can highlight deficits. Palpation often reveals muscle tightness and tenderness.

Patients may report headaches, neck stiffness, upper back ache, or shoulder pain, particularly after prolonged sitting. Neurological symptoms are rare but possible if nerve compression occurs.

A thorough musculoskeletal assessment helps rule out differential diagnoses such as cervical disc pathology, shoulder impingement, or thoracic outlet syndrome. Formal imaging is not typically necessary unless red flag symptoms are present.

Do I need an Xray or other Imaging?

In most cases, UCS is diagnosed clinically without the need for imaging. However, imaging may be used to rule out underlying pathology or if symptoms are atypical. Plain X-rays can demonstrate postural changes such as increased cervical lordosis or thoracic kyphosis, while MRI or CT scans may be indicated if neurological signs suggest disc herniation or nerve compression. Imaging is generally reserved for patients with trauma history, severe pain, or red flag symptoms (e.g., unexplained weight loss, night pain, neurological deficits). For the majority, imaging adds little to routine management.

Treatment

Effective treatment of UCS targets both tight and weak muscles while addressing contributing lifestyle factors. Stretching is crucial for lengthening shortened muscles, particularly the pectoralis major/minor, upper trapezius, and levator scapulae. Strengthening focuses on activating inhibited muscles, including the deep cervical flexors, lower trapezius, and serratus anterior. Common exercises include chin tucks, scapular retraction drills, and thoracic extension work. For a basic program, check out the exercises at the top of this page.

Manual therapy such as soft tissue release, joint mobilisation, and myofascial techniques can help relieve muscle tension and improve movement.

Ergonomic education plays a vital role: adjusting desk height, chair support, and screen positioning reduces postural strain. Encouraging frequent breaks from sitting and integrating postural awareness strategies throughout the day are also key.

Adjuncts such as kinesiology taping or posture braces may provide short-term relief, but long-term correction relies on active rehabilitation. In athletes, balancing training loads between pushing and pulling exercises is essential to prevent recurrence. Multidisciplinary input (e.g., physiotherapy and exercise physiology) may be valuable in chronic cases. With consistent effort, most patients respond well to a structured program.

How long is it going to take?

The prognosis for UCS is excellent when addressed early with targeted rehabilitation and lifestyle changes. Mild cases often show improvement within 4–6 weeks of consistent stretching and strengthening. Moderate or chronic cases may require 8–12 weeks or longer, especially if poor posture habits are deeply ingrained.

Long-term resolution depends on maintaining postural awareness, continuing exercise, and minimizing sedentary behaviours.

Without intervention, symptoms may persist or worsen, but with adherence to treatment, most individuals achieve full functional recovery and sustained symptom relief.

The Take Home

Upper Crossed Syndrome is a common, posture-related condition caused by predictable muscle imbalances. It often presents with neck pain, headaches, and rounded shoulder posture, especially in people with sedentary or screen-heavy lifestyles. The condition is reversible with targeted rehabilitation that stretches tight muscles, strengthens weak ones, and addresses ergonomic and lifestyle contributors. Early recognition and consistent treatment lead to excellent outcomes, while neglecting the problem can prolong discomfort. Awareness, prevention, and simple corrective strategies are the keys to keeping the upper body strong, mobile, and pain-free.

Got neck and shoulder pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your neck and shoulder pain and let you know whether you have upper crossed syndrome, referred shoulder pain, osteoarthritis, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Bayattork, M., Seidi, F., Minoonejad, H., Andersen, L. L., & Page, P. (2020). The effectiveness of a comprehensive corrective exercises program and subsequent detraining on alignment, muscle activation, and movement pattern in men with upper crossed syndrome: protocol for a parallel-group randomized controlled trial. Trials, 21(1), 255. https://doi.org/10.1186/s13063-020-4159-9
Jeong, G. H., & Lee, B. H. (2024). Effects of Telerehabilitation Combining Diaphragmatic Breathing Re-Education and Shoulder Stabilization Exercises on Neck Pain, Posture, and Function in Young Adult Men with Upper Crossed Syndrome: A Randomized Controlled Trial. Journal of clinical medicine, 13(6), 1612. https://doi.org/10.3390/jcm13061612
Khosravi, Z., Mohammad Ali Nasab Firouzjah, E., & Firouzjah, M. H. (2024). Comparison of balance and proprioception of the shoulder joint in girls with and without upper cross syndrome. BMC musculoskeletal disorders, 25(1), 618. https://doi.org/10.1186/s12891-024-07552-5
Seidi, F., Bayattork, M., Minoonejad, H., Andersen, L. L., & Page, P. (2020). Comprehensive corrective exercise program improves alignment, muscle activation and movement pattern of men with upper crossed syndrome: randomized controlled trial. Scientific reports, 10(1), 20688. https://doi.org/10.1038/s41598-020-77571-4
Sepehri, S., Sheikhhoseini, R., Piri, H., & Sayyadi, P. (2024). The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis. BMC musculoskeletal disorders, 25(1), 105. https://doi.org/10.1186/s12891-024-07224-4
Yaghoubitajani, Z., Gheitasi, M., Bayattork, M., & Andersen, L. L. (2021). Online supervised versus workplace corrective exercises for upper crossed syndrome: a protocol for a randomized controlled trial. Trials, 22(1), 907. https://doi.org/10.1186/s13063-021-05875-5

The Foot - Jones Fracture

Tue, 16 Sep 2025 05:10:18 GMT

If you've injured your foot, early assessment is crucial to avoid a poor outcome.

A Jones fracture is a specific type of fracture that occurs at the metaphyseal-diaphyseal junction of the fifth metatarsal, approximately 1.5 cm distal to the tuberosity. This fracture is notorious for its high risk of nonunion and delayed healing due to the limited blood supply in this region. Proper diagnosis and management are crucial to ensure optimal recovery and prevent complications.

Anatomy 101

The fifth metatarsal is one of the five long bones in the foot, located on the lateral side . It consists of a base, shaft, neck, and head. The Jones fracture specifically occurs at the metaphyseal-diaphyseal junction. This region is biomechanically significant because it represents a transition between spongy (cancellous) bone and dense (cortical) bone.

It is also a watershed area with limited blood supply , which explains the increased risk of delayed union or non-union.

The peroneus brevis tendon attaches to the base of the fifth metatarsal, and the lateral band of the plantar fascia inserts nearby, both of which can influence the mechanics and healing of fractures in this region. Understanding the anatomy of this bone and its vascularity is essential for differentiating a Jones fracture from other fifth metatarsal injuries and for determining the most appropriate management plan.

Who gets it?

Jones fractures are relatively common, particularly among athletes and individuals engaged in high-impact activities. They account for a significant proportion of fifth metatarsal fractures. The incidence is higher in younger, active populations, with a notable prevalence in sports such as basketball, soccer, and running, where repetitive stress and acute trauma are common. While they can occur in the general population after an awkward twist or fall, younger adults and athletes are at higher risk. Because of their higher rate of complications compared with other metatarsal fractures, Jones fractures are an important condition for clinicians, coaches, and patients to recognise early.

Diagnosing Jones Fractures

Diagnosis of a Jones fracture typically involves a combination of clinical evaluation and imaging. Patients often present with pain and swelling on the lateral aspect of the foot, exacerbated by weight-bearing activities. Physical examination may reveal tenderness at the base of the fifth metatarsal.

Clinicians must distinguish a Jones fracture from an avulsion fracture (closer to the tuberosity) or a stress fracture (further along the shaft), as management differs.

History taking is key—acute fractures are linked to trauma, while stress-related fractures develop more gradually. Functional testing, such as walking or hopping, may be painful or impossible. Because of the risk of misdiagnosis, clinical suspicion should be confirmed by appropriate imaging to avoid delays in treatment.

Do I need a scan?

Initial imaging for a suspected Jones fracture includes standard foot radiographs ( anteroposterior , lateral, and oblique views ). These views help confirm the diagnosis and assess the fracture's location and displacement. The fracture line is usually transverse and located at the metaphyseal-diaphyseal junction. In some cases, advanced imaging such as MRI or CT may be warranted to assess for complications like nonunion or to evaluate the extent of the injury. In cases where the diagnosis is uncertain or complications are suspected, MRI or CT scans can provide detailed information on the fracture and surrounding soft tissues, aiding in comprehensive management planning.

Treatment

The treatment of Jones fractures can be either nonoperative or operative, depending on the patient's activity level, fracture type, and risk factors for nonunion. Nonoperative management typically involves immobilization in a non-weight-bearing cast or boot for 6-8 weeks, followed by gradual weight-bearing as tolerated. This approach is often reserved for less active individuals or those with type I fractures according to the Torg classification .

Strict adherence is crucial, as premature loading can delay healing.

Operative treatment is generally preferred for athletes and active individuals due to the higher union rates and quicker return to activity. Intramedullary screw fixation is the standard surgical technique, providing stable fixation and promoting early mobilization. Plate fixation is another option, though less commonly used. Postoperative protocols may include early weight-bearing in a controlled ankle motion boot, with a gradual transition to regular shoes and activities.

Adjunctive measures such as physiotherapy, gradual strengthening, balance training, and footwear modifications support recovery and reduce reinjury risk.

Patient education is vital — smoking, poor nutrition, and early return to activity can all compromise healing outcomes. Regular follow-up ensures the fracture is uniting as expected.

How long’s it going to take?

The prognosis for Jones fractures varies based on treatment modality and patient factors. Nonoperative management typically results in healing within 10-12 weeks, though the risk of nonunion is higher. Operative treatment, particularly with intramedullary screw fixation, often leads to faster healing, with most patients returning to full activity within 8-12 weeks. However, complications such as refracture and delayed union can occur, necessitating careful follow-up.

The Take Home

A Jones fracture is a specific and clinically significant injury of the fifth metatarsal with a known risk of poor healing. Jones fractures require prompt and accurate diagnosis, with treatment tailored to the patient's activity level and fracture characteristics. While nonoperative management is suitable for some, surgical fixation is often preferred in athletes to ensure quicker and more reliable healing. Close monitoring and appropriate rehabilitation are essential to optimize outcomes and prevent complications.

Injured your foot and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess your foot and identify whether the you have a Jones fracture, avulsion fracture, or if something else is causing your pain. With a clear diagnosis and tailored management plan, we’ll help get you back on your feet sooner.

�� Call us now or click BOOK AN APPOINTMENT to book online.

References

Açak, M. (2020). The effects of individually designed insoles on pes planus treatment. Scientific Reports, 10(1), 19715.
Blasimann, A., Nötzli, A., Schaffner, L., & Baur, H. (2015). Non-surgical treatment of pes planovalgus associated pain—a systematic review. Physiotherapy, 101, e130-e131.
Hakeem, W. & Rashid, F. (2024). Flat feet and bone health: An orthopedic review of impacts on long-term musculoskeletal health and management strategies. International Journal of Orthopaedics Sciences, 10(3): 295-307. DOI: https://doi.org/10.22271/ortho.2024.v10.i3d.3655
Raj MA, Tafti D, Kiel J. Pes Planus. (2025). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/
Rodriguez, N., Choung, D. J., & Dobbs, M. B. (2010). Rigid pediatric pes planovalgus: conservative and surgical treatment options. Clinics in podiatric medicine and surgery, 27(1), 79-92.
Şahin FN, Ceylan L, Küçük H, Ceylan T, Arıkan G, Yiğit S, Sarşık DÇ, Güler Ö. Examining the Relationship between Pes Planus Degree, Balance and Jump Performances in Athletes. Int J Environ Res Public Health. 2022 Sep 15;19(18):11602. doi: 10.3390/ijerph191811602. PMID: 36141874; PMCID: PMC9517403.
Salinas-Torres, V. M., Salinas-Torres, R.A., Carranza-García, L. E., Herrera-Orozco, J., Tristán-Rodríguez, J.L. (2023). Prevalence and Clinical Factors Associated with Pes Planus Among Children and Adults: A Population-Based Synthesis and Systematic Review. The Journal of Foot and Ankle Surgery, 62 (5), 899-903. https://doi.org/10.1053/j.jfas.2023.05.007 .
Turner, C., Gardiner, M. D., Midgley, A., & Stefanis, A. (2020). A guide to the management of paediatric pes planus. Australian journal of general practice, 49(5), 245-249.
Unver, B., Erdem, E. U., & Akbas, E. (2019). Effects of short-foot exercises on foot posture, pain, disability, and plantar pressure in pes planus. Journal of sport rehabilitation, 29(4), 436-440.

The Foot - Pes Planus (Flat foot)

Fri, 12 Sep 2025 08:08:51 GMT

Flat feet can cause a range of problems further up the kinetic chain, including knee, hip and low back pain.

Try these low impact exercises for flat feet.

Pes planus, commonly referred to as flatfoot, is a condition where the medial longitudinal arch of the foot is diminished or absent, causing most of the sole to contact the ground. Pes planus can be flexible, with the arch reappearing on tiptoe; or rigid, with the arch remaining absent. While many individuals with pes planus are asymptomatic, the condition can disrupt normal biomechanics of the lower limb and spine, leading to an increased risk of pain, dysfunction, and injury.

Anatomy 101

The medial longitudinal arch is the primary and highest arch of the foot, running along the inside (medial side) from the heel (calcaneus) through to the first three metatarsal bones. It is supported by bones, ligaments (such as the spring ligament and plantar fascia), and muscles (notably the tibialis posterior, tibialis anterior, and intrinsic foot muscles). Its main roles in normal biomechanics is to:

Absorb shock during weight-bearing activities.
Store and release elastic energy to aid propulsion in gait.
Distribute loads across the foot and lower limb.
Maintain stability and balance , adapting to uneven surfaces.

This arch is critical for efficient walking and running, protecting joints higher up the kinetic chain.

During the stance phase of the gait cycle, the medial longitudinal arch lowers, increasing the contact surface area with the ground, distributing load evenly and allowing the foot to adapt to the terrain. As the stance phase progresses and the heel starts to lift, the arch starts to rise, stiffening the foot and converting it into a stable lever with stored energy to aid propulsion.

In pes planus (flatfoot) , the normal dynamic function of the medial longitudinal arch is altered. The arch is abnormally low or absent, resulting in reduced shock absorption, altered alignment and reduced propulsion efficiency. This can lead to increased stress on joints and soft tissues, including the knees, hips and lower back.

Who gets it?

Pes planus is common, affecting between 20% and 37% of the population. It occurs across the lifespan, but the underlying causes and risk factors differ by age and population group. Flatfoot is common in infants and children due to undeveloped arches, with most resolving by age 6–8, though some remain flexible into adolescence and young adulthood due to arches not fully developing.

Acquired pes planus can occur from adolescence through to old age due to neuromuscular conditions, muscle and tendon dysfunction and weakness, ligament injury, trauma, arthritis, or overuse.

At risk groups include athletes, especially runners, people with obesity, diabetes, connective tissue disorders (e.g., Marfan, Ehlers-Danlos), or occupations requiring prolonged standing. Children with Down syndrome are at higher risk of pes planus, while people with cerebral palsy may present with flexible or rigid pes planus.

Rigid flatfoot is rare and often congenital, associated with conditions such as tarsal coalition, vertical talus, or accessory navicular bones.

What does the research say?

Research shows that flat feet require more energy during movement due to instability and increased muscle strain. Pes planus alters the foot’s alignment, leading to excessive pronation, calcaneal valgus, and changes in joint positioning. These disruptions affect how the body senses and controls posture, forcing muscles to work harder to maintain balance—especially during walking.

While some studies suggest pes planus impairs foot control, balance, and jump performance, others have found no significant impact on athletic abilities such as vertical jump height and sprint. The evidence remains mixed, and any performance issues may arise from long-term complications rather than the condition itself.

Common Symptoms

Pes planus generally does not cause symptoms per se. Rather it causes alterations to normal biomechanics that can result in symptom development either locally or proximal to the feet. These include:

Foot pain (heel, midfoot, or arch)
Fatigue during walking/standing
Postural imbalance or altered gait
Referred pain to knees, hips, or lower back

Conditions often related to pes planus include plantar heel pain , Achilles Tendinopathy , Bunions and Hammertoe.

Assessment and Diagnosis

In most cases, a qualified physiotherapist can assess for the presence of pes planus and, if present, ascertain its relevance to the presenting signs and symptoms. This might include observations of functional activities such as walking and running, the Navicular drop test, Windlass tess, and the Foot Posture Index.

It is crucial that, in the presence of pes planus, a thorough assessment is undertaken to identify related pathology contributing to symptoms such as plantar heel pain or Achilles Tendinopathy.

Do I Need a Scan?

Imaging (X-Ray, MRI, Ultrasound) is not usually indicated for flexible pes planus unless the presentation raises certain flags (eg. prominent paediatric fat pad, oedema, or suggestive of fibroma, tumour or lipoma). If rigid pes planus is suspected then imaging should be undertaken to rule in/out underlying pathology (e.g., tarsal coalition).

Treatment and Management

Physiotherapy is often the first line management for pes planus. Treatment includes soft tissue therapy, exercise therapy (stretching and strengthening, proprioceptive training), taping and/or off-the-shelf orthotics, and education and lifestyle advice.

Other treatment should address related symptoms, which might require a period of manual and soft tissue therapy and load reduction to control pain.

Will I need surgery?

Surgical intervention is generally reserved for rigid flatfoot where there is significant pain or mobility limitations, or for failed conservative treatment. Surgical procedures can include tendon transfers, ligament reconstruction, osteotomies and arthrodesis (joint fusion).

How long is it going to take?

In children, pes planus usually resolves by age 6-8 with little to no intervention. Flexible flatfoot that persists beyond this age or is acquired later in life rarely resolves requiring symptomatic treatment and management of related conditions. The good news is that most of these can be well managed with little impact on sport and daily lifestyle activities.

The Take Home

Pes planus is common, often benign, and in many cases, self-resolving—especially in children. When intervention is needed, conservative physiotherapy-led care is the first-line approach. Strengthening, stretching, education, and tailored orthotics can significantly improve function and reduce symptoms related to pes planus. With proper guidance, most individuals can lead active, pain-free lives without the need for surgical intervention.

Got flat feet and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess your feet and identify whether they are contributing to your symptoms. With a clear diagnosis and tailored management plan, we’ll help get you back on your feet sooner.

�� Call us now or click BOOK AN APPOINTMENT to book online.

References

Açak, M. (2020). The effects of individually designed insoles on pes planus treatment. Scientific Reports, 10(1), 19715.
Blasimann, A., Nötzli, A., Schaffner, L., & Baur, H. (2015). Non-surgical treatment of pes planovalgus associated pain—a systematic review. Physiotherapy, 101, e130-e131.
Hakeem, W. & Rashid, F. (2024). Flat feet and bone health: An orthopedic review of impacts on long-term musculoskeletal health and management strategies. International Journal of Orthopaedics Sciences, 10(3): 295-307. DOI: https://doi.org/10.22271/ortho.2024.v10.i3d.3655
Raj MA, Tafti D, Kiel J. Pes Planus. (2025). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430802/
Rodriguez, N., Choung, D. J., & Dobbs, M. B. (2010). Rigid pediatric pes planovalgus: conservative and surgical treatment options. Clinics in podiatric medicine and surgery, 27(1), 79-92.
Şahin FN, Ceylan L, Küçük H, Ceylan T, Arıkan G, Yiğit S, Sarşık DÇ, Güler Ö. Examining the Relationship between Pes Planus Degree, Balance and Jump Performances in Athletes. Int J Environ Res Public Health. 2022 Sep 15;19(18):11602. doi: 10.3390/ijerph191811602. PMID: 36141874; PMCID: PMC9517403.
Salinas-Torres, V. M., Salinas-Torres, R.A., Carranza-García, L. E., Herrera-Orozco, J., Tristán-Rodríguez, J.L. (2023). Prevalence and Clinical Factors Associated with Pes Planus Among Children and Adults: A Population-Based Synthesis and Systematic Review. The Journal of Foot and Ankle Surgery, 62 (5), 899-903. https://doi.org/10.1053/j.jfas.2023.05.007 .
Turner, C., Gardiner, M. D., Midgley, A., & Stefanis, A. (2020). A guide to the management of paediatric pes planus. Australian journal of general practice, 49(5), 245-249.
Unver, B., Erdem, E. U., & Akbas, E. (2019). Effects of short-foot exercises on foot posture, pain, disability, and plantar pressure in pes planus. Journal of sport rehabilitation, 29(4), 436-440.

The Foot - Plantar Heel Pain

Thu, 11 Sep 2025 04:13:12 GMT

Heel pain that won't quit? Why starting physiotherapy early matters.

Try these low impact exercises for mild heel pain

Plantar heel pain is one of the most common causes of pain in the foot, particularly for people who spend a lot of time on their feet or who enjoy participating in running sports. For years it was called “plantar fasciitis,” (pronounced fa-shee- ai - tuhs, which translates to inflammation (-itis) of the fascia), but research now shows it’s often more complex than simple inflammation. Persistent heel pain can affect your walking, running, and daily life — but early physiotherapy can make a big difference in recovery.

Anatomy 101

The heel is supported by the plantar fascia , a strong band of tissue running from the calcaneus (heel bone) to the base of your toes. It acts like a shock absorber and maintains the arch of your foot, particularly from mid-stance to toe off during walking and running.

The plantar fascia has a rich nerve input and a limited blood supply, which means it can cause sharp, disabling pain and be slow to heal.

Every step loads this structure, so even small injuries or tissue changes can have a big impact on day-to-day function.

I heard of this under another name?

Traditionally called plantar fasciitis, we now know most cases involve degenerative changes rather than inflammation or specific structural changes, so “plantar heel pain” is a more accurate description when describing this condition. Other names you might hear include:

Heel spur syndrome
Policeman’s heel
Jogger’s heel

These terms can be misleading — for instance, heel spurs are often present in people without pain, and heel pain is not exclusive to law enforcement personnel or joggers. “Plantar heel pain” better reflects what’s actually happening in your foot.

Who gets it?

Heel pain affects a wide range of people.

It is estimated that up to 10% of the population will experience plantar heel pain at some point in their lifetime, and it accounts for 25% of all foot disorders in athletes.

Risk factors for plantar heel pain include:

Middle aged Adults (40-60), but active younger populations can also be affected
Jobs with long standing or walking hours
Runners and athletes with sudden training increases
Flat feet (pes planus) or very high arches (pes cavus)
Weight gain or being overweight
Darwin footwear (Thongs & Barefoot)

Diagnosing Plantar Heel Pain

Diagnosis of plantar heel pain is primarily based on clinical findings, something physiotherapists are well trained to assess. Symptoms can include heel pain when weight-bearing after a period of non-weight bearing (eg. first thing in the morning), pain that eases with initial activity then increases with further use, and pain after prolonged standing, walking or jogging.

Signs related to plantar heel pain include:

Tenderness at the heel’s inner edge & along plantar fascia
Pain when stretching the toes upward
Weakness in calf or foot muscles
Pain proportional to loading the plantar fascia

Other conditions the physiotherapist will want to rule out include stress fractures, nerve entrapment, fat pad atrophy, tarsal tunnel syndrome, or systemic inflammation. Tests like the Windlass test can confirm plantar fascia involvement in heel pain presentations, but it’s important to have a health professional diagnose you correctly to ensure you get the best treatment.

Do I need a scan?

Most people don’t need imaging. Ultrasound or MRI is reserved for unusual or chronic presentations. X-rays may reveal heel spurs, but these are usually incidental and not the true source of pain.

Treatment

Physiotherapy is the first-line treatment and there is good evidence for its effectiveness. Treatment strategies include:

Load management: Adjust activity to the load going through the plantar fascia while staying active
Stretching & manual therapy: Relieve stiffness in the fascia and calf
Strengthening exercises: Calf raises and intrinsic foot exercises support the foots arch
Taping or orthotics: Temporary support to reduce pain while walking
Hydrotherapy: Gentle water-based exercise to maintain fitness and reduce load

Other second-line interventions with lower quality evidence include the use of anti-inflammatories for short-term pain relief and shockwave therapy. Massage guns are not recommended as they have no effect on the underlying causes of heel pain.

Do I need surgery? What about an injection?

Cortisone (steroid) injections and surgery for heel pain are rarely indicated and reserved for those with persistent pain that has been resistant to conservative treatment strategies.

How long’s it going to take?

Recovery depends on early intervention and strict adherence to a rehabilitation plan. Mild cases often improve in 6–8 weeks, while chronic or severe cases may take 3–6 months. Consistent exercise, load management, and physiotherapy guidance are key to a faster recovery.

The Take Home

Heel pain isn’t just a minor irritation — it’s a condition that can limit walking, running, and daily life if left unmanaged. Early assessment, diagnosis, and physiotherapy-focused rehabilitation are crucial. With the right plan, most people can reduce their pain and return to the activities they love.

Got heel pain and want to get it sorted? Give us a call today.

Got heel pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess your heel pain, identify whether it’s plantar heel pain or another condition. With a clear diagnosis and tailored management plan, we’ll help get you back on your feet sooner.

�� Call us now or click BOOK AN APPOINTMENT to book online.

References

Babatunde, O. O., Legha, A., Littlewood, C., Chesterton, L. S., Thomas, M. J., Menz, H. B., ... & Roddy, E. (2019). Comparative effectiveness of treatment options for plantar heel pain: a systematic review with network meta-analysis. British journal of sports medicine, 53(3), 182-194.
Koc, T. A., Jr, Bise, C. G., Neville, C., Carreira, D., Martin, R. L., & McDonough, C. M. (2023). Heel Pain - Plantar Fasciitis: Revision 2023. The Journal of orthopaedic and sports physical therapy, 53(12), CPG1–CPG39. https://doi.org/10.2519/jospt.2023.0303Landorf, K. B. (2015). Plantar heel pain and plantar fasciitis. BMJ clinical evidence, 2015, 1111.
Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & Godges, J. J. (2014). Heel pain—plantar fasciitis: revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.
Morrissey, D., Cotchett, M., Said J'Bari, A., Prior, T., Griffiths, I. B., Rathleff, M. S., Gulle, H., Vicenzino, B., & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British journal of sports medicine, 55(19), 1106–1118. https://doi.org/10.1136/bjsports-2019-101970
Riel, H., Cotchett, M., Delahunt, E., Rathleff, M. S., Vicenzino, B., Weir, A., & Landorf, K. B. (2017). Is 'plantar heel pain' a more appropriate term than 'plantar fasciitis'? Time to move on. British journal of sports medicine, 51(22), 1576–1577. https://doi.org/10.1136/bjsports-2017-097519
Rosenbaum, A. J., DiPreta, J. A., & Misener, D. (2014). Plantar heel pain. Medical Clinics, 98(2), 339-352.
Salvioli, S., Guidi, M., & Marcotulli, G. (2017). The effectiveness of conservative, non-pharmacological treatment, of plantar heel pain: a systematic review with meta-analysis. The Foot, 33, 57-67.
Sullivan, J., Burns, J., Adams, R., Pappas, E., & Crosbie, J. (2015). Musculoskeletal and activity-related factors associated with plantar heel pain. Foot & ankle international, 36(1), 37-45.
Sullivan, J., Pappas, E., & Burns, J. (2020). Role of mechanical factors in the clinical presentation of plantar heel pain: Implications for management. The Foot, 42, 101636.
Sweeting, D., Parish, B., Hooper, L., & Chester, R. (2011). The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. Journal of foot and ankle research, 4(1), 19.

The Hip - Femoroacetabular Impingement (FAI)

Tue, 26 Aug 2025 10:23:25 GMT

Femoroacetabular impingement (FAI) is a common cause of hip and groin pain in active individuals.

Femoroacetabular impingement (FAI) is a condition where abnormal contact between the femoral head and the acetabulum (hip socket) causes joint damage. It occurs when bone growth—either on the femoral head (cam type), the acetabulum (pincer type), or both—interfere with normal hip movement. This repeated contact can damage the labrum and cartilage, leading to pain, stiffness, and reduced range of motion.

FAI often affects young, active individuals and may lead to early hip osteoarthritis.

Symptoms include groin pain during activity or prolonged sitting. Diagnosis involves a physical examination and imaging, and treatment incorporating physiotherapy, medication, and in some instances, steroid injections or surgery.

Anatomy 101

The Femoral acetabular joint, or hip joint , is likened to a “ball and socket” joint, where the “ball” (the femoral head) is encapsulated by the “socket” (the acetabulum of the pelvis). When an individual experiences FAI, there is a structural abnormality of either the “ball” or the “socket”, or both. Abnormalities can be caused by genetics and/or a response to damage and stress, known as osteophyte growth. This leads to incongruence of the hip joint, where soft tissue structures of the hip joint can get pinched during movement.

FAI can be caused by a CAM lesion (when the “ball” or head of femur is mis-formed), a Pincer lesion (when the “socket” or the acetabulum is mis-formed), or a combination of both.

Who gets it?

While FAI can occur in adolescents, particularly those involved in sports during skeletal development, it most commonly affects young to middle-aged adults, typically between the ages of 20 and 50.

FAI is more prevalent in males, and in high impact or kicking sports such as AFL, soccer, hockey and basketball.

Other factors that influence the development of FAI include a family history of hip pain, and occupations that involve prolonged periods of sitting and repetitive, deep squatting. Occasionally FAI can result from muscular weakness and poor motor control of hip musculature.

Diagnosing

FAI can be diagnosed through a thorough subjective and objective assessment taken by your physiotherapist. Some key signs and symptoms of FAI can include pain in the front/groin area of your hip, joint clicking and occasional locking. These can often be reproduced with deep squatting or other movements towards the limit of hip range of motion.

Other similar presenting hip pathologies or differential diagnoses may be:

Hip joint osteoarthritis
Acute hip labral tears
Fracture or stress fractures of the femur
Inguinal hernias
Reproductive organ / pelvic floor dysfunctions
Lumbar spine referral

A physiotherapist will be able to diagnose FAI by some of the following objective assessments:

Pain location: localised most to the front of the hip if we are suspecting hip joint related pain, such as FAI.
Hip joint range of motion (ROM): In individuals with FAI, hip joint ROM may be decreased, more specifically, combined hip F lexion, AD uction + I nternal R otation (FADIR) may be limited and painful.
Muscle strength: decreased hip flexor, extensor, adductor, abductor, internal and external muscle strength and endurance may be decreased.

In some cases, a GP may be helpful to refer to a sports medicine physician or orthopaedic specialist if initial diagnostic tests are inconclusive.

Do I need a scan?

Following a thorough physical examination, medical imaging may be helpful in confirming a diagnosis of FAI, determining the best treatment approach, and ruling out other potential causes of hip pain. This can include XR, MRI or other imaging modalities where indicated. Xrays may be ordered by your physiotherapist to assess the bony morphology of your hip joint.

An MRI can assist to further assess the hip joint, especially when considering other causes of hip pain such as cartilage tears, inflammation, and osteoarthritis.

Some “structural abnormalities” can be a normal variant of anatomy and research has found that individuals can have structural irregularities on imaging and remain asymptomatic. It is therefore important to consider both the clinical and radiological findings when making a diagnosis of FAI.

Treatment

Conservative management is typically the first and preferred line of treatment for mild to moderate FAI. This is typically provided by a physiotherapist with input from your GP or Sports Medicine Physician to provide pharmacological intervention if required.

Phase 1 intervention for FAI involves a period of de-escalating symptoms (pain and stiffness) and finding a level of activity that the hip joint copes with. Manual therapy such as massage, joint mobilisation, dry needling, and taping can be effective in this phase of treatment for pain relief and improved movement and control. Hydrotherapy can be an excellent in phase 1 for hips that continue to be irritable.

Phase 2 commences once pain is adequately controlled and normal movement has been restored. Phase 2 rehab involves addressing hip and core strength, joint range of motion, motor control and proprioception in a controlled environment under the guidance of a skilled physiotherapist who understands the pathology of FAI. Exercises target individual muscles and actions, working on strength, power and control.

Phase 3 rehab involves introducing movement patterns and graduated return to activity. Tasks are specific to the individual and their goals, with a focus on cross training and functional rehabilitation to ensure a safe and successful return to sport and daily living.

Throughout the process your physiotherapist will provide education and advice regarding safe, graded loading of the hip joint, and expert tips on how to stay pain free in the future.

How long’s it going to take?

FAI typically develops over a prolonged period of exposure to certain activities, and it can take a while to settle irritated structures down to the point they can tolerate load again. This can vary depending on the individual, how irritable the hip joint is, and how diligent you are at following a rehab program. In most instances pain can usually be settled with 2-4 weeks. Phase 2 usually lasts approximately 6 weeks, with phase 3 dependent on the level of activity you are returning to, but normally about 3-6 weeks.

All up, expect FAI to take between 3 and 4 months to resolve completely and for you to return to your pre-existing level of activity.

What about surgery? Or an injection?

Your physiotherapist can advise regarding surgery and injections, including the risks associated with each approach. In some recalcitrant cases, corticosteroid injection into the affected space can improve symptoms, allowing for more effective management with your physiotherapist. Advanced cases of FAI may require surgery to debulk the lesion and/or osteophytes causing impingement. This can be undertaken arthroscopically, and the outcomes are generally very good.

The Take Home

Early intervention for hip FAI is important to limit muscle deconditioning and irritation of hip joint structures. The longer you put up with symptoms, chances are the longer the rehabilitation process will be and the greater the chance of requiring more invasive managemetn approaches. Early intervention will limit time lost from work and sport and help to prevent progression to hip joint osteoarthritis. With efficient assessment, diagnosis and treatment from a physiotherapist, most cases of hip FAI can be well managed conservatively and prevent further complications.

Got anterior hip and/or groin pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your hip pain and let you know whether you have FAI, hip joint osteoarthritis, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Fortier, L. M., Popovsky, D., Durci, M. M., Norwood, H., Sherman, W. F., & Kaye, A. D. (2022). An updated review of femoroacetabular impingement syndrome. Orthopedic reviews, 14(3), 37513.
Lucenti, L., Maffulli, N., Bardazzi, T., Saggini, R., Memminger, M., Simeone, F., & Migliorini, F. (2024). Return to sport following arthroscopic management of femoroacetabular impingement: a systematic review. Journal of Clinical Medicine, 13(17), 5219.
Pasculli, R. M., Callahan, E. A., Wu, J., Edralin, N., & Berrigan, W. A. (2023). Non-operative management and outcomes of femoroacetabular impingement syndrome. Current reviews in musculoskeletal medicine, 16(11), 501-513.
Schmaranzer, F., Kheterpal, A. B., & Bredella, M. A. (2021). Best practices: hip femoroacetabular impingement. American Journal of Roentgenology, 216(3), 585-598.
Terrell, S. L., Olson, G. E., & Lynch, J. (2021). Therapeutic exercise approaches to nonoperative and postoperative management of femoroacetabular impingement syndrome. Journal of athletic training, 56(1), 31-45.
Zogby, A. M., Bomar, J. D., Johnson, K. P., Upasani, V. V., & Pennock, A. T. (2021). Nonoperative management of femoroacetabular impingement in adolescents: clinical outcomes at a mean of 5 years: a prospective study. The American Journal of Sports Medicine, 49(11), 2960-2967.

The Wrist - Scaphoid Fracture

Tue, 26 Aug 2025 03:45:48 GMT

Scaphoid fractures require careful, early intervention to avoid long-term complications.

Try these low impact exercises for mild wrist pain

Scaphoid Fractures are one of the most common carpal (hand bone) fractures. Scaphoid fractures can be a lengthy fracture to rehabilitate if not diagnosed and managed correctly. Early diagnosis and treatment of a scaphoid fracture is vital.

Anatomy 101

The scaphoid is one of eight small bones in our hand called carpal bones. The scaphoid is located on the radial (thumb) side of our hand, near the base of the thumb, and provides an attachment point for many ligaments in the wrist. See how to palpate the scaphoid bone here .

The scaphoid is an important part of the wrist complex, providing structural stability and smooth movement to the wrist joint.

The scaphoid is unique in that it has a limited blood supply that can be disrupted when the scaphoid is injured. Blood gets from the distal pole to the proximal pole of the scaphoid through retrograde blood flow from the dorsal scaphoid branch of the radial artery. Because of this, a scaphoid fracture can be deemed high risk injury, with complications of a scaphoid fracture including non-union and avascular necrosis (bone cell death), osteoarthrosis and wrist joint instability if not managed correctly.

Who gets it?

The scaphoid is the most commonly fractured carpal bone, with at least 60% of carpal fractures involving the scaphoid bone, accounting for about 11% of all hand fractures. Scaphoid fractures are most common in young males aged between 15 to 25 and commonly occur after a traumatic fall onto an outreached hand ( FOOSH ). However, it can occur to anyone who has a fall onto their hand, as well as in atraumatic cases.

Diagnosing a scaphoid fracture

A person with a scaphoid fracture will typically describe a mechanism of injury of a FOOSH, with radial (thumb side) wrist pain, or pain at the base of the thumb. They also may experience swelling around the base of the thumb, and tenderness throughout this area. Wrist and thumb range of motion may be limited, and there is often difficulty with grip strength and weight bearing throughout the hand.

Other conditions that could present like a scaphoid fracture can include other carpal bone fractures, distal radius fracture , scapho-lunate ligament injury, triangular fibrocartilage complex injury , or a wrist or thumb joint sprain (such as skier's thumb or gamekeeper's thumb ). A physiotherapist can perform some assessments to help diagnose a scaphoid fracture. Common tests include radial snuff box tenderness, scaphoid tubercle tenderness and scaphoid axial loading and compression through the thumb / applying stress to the area.

Do I need a scan?

If a scaphoid fracture is suspected, a Xray is pivotal to management of this condition. This can often be organized through your physiotherapist, GP or emergency department if it is clinically suspected. If not found on initial Xray (common in non-displaced fractures), but still clinically suspected, the wrist should be immobilized in a cast and managed as a suspected scaphoid fracture for 2 weeks. If a scaphoid fracture is present, Xray at this time will demonstrate early fracture callous formation. CT or MRI can also help to diagnose a scaphoid fracture.

Treatment

Because the scaphoid bone has a limited blood supply that can be disrupted when injured, there is a high risk of an adverse outcome following this injury.

Suspected scaphoid fractures should be initially managed in a cast, even if initial Xray is negative, with follow-up Xray at 2 weeks.

This allows for early fracture healing without further disruption to blood supply. Failure to effectively immobilize the wrist can disrupt fracture healing requiring surgical fixation with or without bone graft.

If a scaphoid fracture has been confirmed, it is important to manage this injury as promptly as possible. The location of the fracture will determine how the injury is initially managed. Management of a scaphoid fracture can be either conservative (not requiring surgery, just immobilizing in a cast or splint) or surgical (requiring internal fixation). An Orthopaedic Specialist will guide the individual on how the fracture is to be managed.

After the initial period of immobilization (typically 6 weeks), the individual can wean out of their cast or brace when instructed to do so. Physiotherapists are important in this process to provide education about safe and gradual loading of the hand and wrist. After a scaphoid fracture, individuals may also experience stiffness in their wrist and thumb, as well as a loss of strength in the hand and upper limb due to disuse.

Working alongside a physiotherapist is highly recommended in this phase of recovery.

A Physiotherapist can provide a tailored rehabilitation program to address these deficits after a comprehensive assessment has been made. A Physiotherapist-led treatment plan, following a scaphoid fracture may include:

Manual therapy (soft massage, joint mobilizing and other techniques) to aid in pain relief and joint stiffness
Gradual rehabilitation program: gradual stretching and stretching exercises to help address weakness and stiffness.
Education and advice on how to safely return to work, sport or other activities of daily living.

How long is it going to take?

Scaphoid fracture is a unique injury due to its complex and limited blood supply, and early diagnosis is key. Distal and waist fractures typically recover fully in 8-12 weeks if managed correctly, while proximal fractures can take longer. All scaphoid fractures are typically immobilized for 6-10 weeks to allow fracture healing to occur, followed by a 4-6 week period of graded load exposure.

Post fracture complications are common, and some fractures can take up to 6 months for a full recovery.

Careful monitoring is required, and surgical intervention may still be required following a period of conservative management if the fracture fails to satisfactorily unite. Working closely with a physiotherapist during the recovery period will allow for a faster return to pre-injury tasks and activities.

The Take Home

Scaphoid fractures are a very common yet easily missed injury to the hand and wrist. They are complex injuries, and early diagnosis is key to minimizing potential complications and adverse outcomes. A physiotherapist can assess wrist injuries, refer you for initial imaging, and provide guidance on the best course of management should you have a fractured scaphoid. Working with a physiotherapist will allow for an efficient diagnosis and seamless rehabilitation process, with appropriate support and guidance at every stage along the road to recovery.

Got wrist pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your wrist pain and let you know whether you have a scaphoid fracture, a wrist fracture, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Almigdad, A., Al-Zoubi, A., Mustafa, A., Al-Qasaimeh, M., Azzam, E., Mestarihi, S., ... & Almanasier, G. (2024). A review of scaphoid fracture, treatment outcomes, and consequences. International Orthopaedics, 48(2), 529-536.
Clementson, M., Björkman, A., & Thomsen, N. O. B. (2020). Acute scaphoid fractures: guidelines for diagnosis and treatment. EFORT open reviews, 5(2), 96–103. https://doi.org/10.1302/2058-5241.5.190025
Gray, R. R., Halpern, A. L., King, S. R., & Anderson, J. E. (2023). Scaphoid fracture and nonunion: new directions. Journal of Hand Surgery (European Volume), 48(2_suppl), 4S-10S.
Li, N. Y., Dennison, D. G., Shin, A. Y., & Pulos, N. A. (2023). Update to management of acute scaphoid fractures. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 31(15), e550-e560.
Sabbagh, M. D., Morsy, M., & Moran, S. L. (2019). Diagnosis and management of acute scaphoid fractures. Hand Clinics, 35(3), 259-269.
Snaith, B., Walker, A., Robertshaw, S., Spencer, N. J. B., Smith, A., & Harris, M. A. (2021). Has NICE guidance changed the management of the suspected scaphoid fracture: A survey of UK practice. Radiography, 27(2), 377-380.
Suh, N., & Grewal, R. (2018). Controversies and best practices for acute scaphoid fracture management. Journal of Hand Surgery (European Volume), 43(1), 4-12.

The Shoulder - Acromioclavicular (AC) Joint Injury

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 15 Jul 2025 12:38:11 GMT

Why the incidence of AC joint injuries is on the rise (and not just in risk-taking males!).

Try these low impact exercises for mild AC joint pain.

Acromioclavicular (AC) joint injuries are a common sports-related injury that occurs around the “tip” of the shoulder, and their incidence is on the rise in Australia. Why? While the last decade has seen a modest rise overall in people taking up sports such as soccer, basketball and gymnastics, the number of women now playing contact sports like rugby and AFL has risen dramatically. High-speed high-risk activities such as mountain biking and snowboarding have exploded, with young and not-so-young participants encouraged by social media and online channels to engage in greater risk-taking behaviour.

Anatomy 101 – Bear with me, it’s important.

The AC joint connects the acromion (part of the scapula or “shoulder blade”) with the distal end of the clavicle (or “collarbone”) and plays an important role in stabilizing the shoulder and achieving full range of motion throughout the shoulder joint. The AC joint is primarily stabilized by the acromioclavicular ligament and the joint capsule, with secondary ligaments providing critical checks and balances to shoulder joint movement. When stressed, the acromion can be forced away (usually downward) causing degrees of separation between the bones. Depending on the force and direction, associated ligaments may be either stretched or torn resulting in a step deformity, pain, and loss of shoulder function.

Who gets it?

More than 40% of acute shoulder injuries are the result of an AC joint injury. The mechanism of injury is typically acute, the result of high impact or direct trauma to the tip of the shoulder (eg. A fall directly onto or a high impact bump as occurs frequently in AFL, rugby, hockey, and cycling), or from indirect trauma, such as falling onto the elbow or an outreached hand. AC joint injuries are more common between ages of 20-40, with men having a 5-10 times higher risk of sustaining an AC joint injury compared to women.

Diagnosing Acute AC Joint Injuries.

A comprehensive subjective assessment with attention to the mechanism of injury will often alert the physiotherapist to an AC joint injury. Normally there is a history of acute trauma accompanied by instantaneous pain and reduction in shoulder and upper limb function. The AC joint is typically tender on palpation and depending on injury severity, the shoulder may appear “dropped” in appearance or have a lump on the tip of the shoulder, often referred to as a “step” deformity.

Your physiotherapist can perform several special tests that can help diagnose an AC joint injury and its grade, as well as clearing other possible causes for your pain. Other injuries can present like an acute AC joint injury such as fractures (clavicle, scapular, humeral head), glenohumeral joint dislocations , labral tears or SLAP lesions or a flare up of a chronic injury (ie. AC joint osteoarthritis, osteolysis), so it is important to have a skilled physiotherapist assess you as soon as possible following injury.

What’s next? Xrays? Surgery?

Xray is typically indicated with AC joint injury where there is suspicion of a large joint separation and/or the clinician suspects a fracture. Xray can have a role in determining the degree of separation and the best course of management, particularly in complex presentations and time-sensitive environments.

The Rockwood classification system is used by radiologists to categorize AC joint injuries. Using radiological measurements injuries are categorized as level 1 (mild) through to level 6 (severe). Those graded 3+ usually require further investigation (MRI) and referral for an orthopaedic consultation for possible surgical fixation.

What to do, what to do?

The good news is that, in the most cases, there is a lot that physiotherapy can do to assist with AC joint injuries. Treatment for AC joint injuries typically involves a short period of immobilization in a collar and cuff sling for comfort, then working with a physiotherapist through a progressive rehabilitation program. Treatment for low grade ACJ injuries (grade 1–2) are typically conservative or “non-operative”. Physiotherapy can provide manual techniques (ie. Soft tissue massage of surrounding structures, joint mobilisation, taping) to aid in pain relief, and early therapeutic exercise and/or hydrotherapy. As pain settles and range of motion returns, physiotherapists can provide progressive functional strength and conditioning programs, as well as expert advice regarding returning to sport, work or activities of daily living.

If surgical repair is required physiotherapy generally commences early in the recovery period as pain permits, following a similar program as to non-surgical management.

How long is it going to take?

Recovery from an AC joint injury depends on the grade of injury, whether surgical fixation is required, and on commitment and compliance to rehabilitation. Typically, a lower grade AC joint injury will take 3-6 weeks to resolve if conservatively managed with physiotherapy. Higher grade injuries and those requiring surgical management will typically take longer period and can be guided by the treating clinician and surgeon.

The Take Home

An AC joint injury is a painful injury impacting normal shoulder function and causing variable disruption to work, sport or other activities of daily living. Physiotherapy plays a vital role in accurate assessment, diagnosis and treatment of an AC joint injury. Early assessment and intervention permits a faster recovery, usually with superior clinical and functional outcomes. By working closely with a physiotherapist, individuals who sustain an AC joint injury will achieve optimal outcomes and return to their pre-injury levels as soon as possible.

Come a cropper and injured your AC joint? Want to get it sorted fast? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose your shoulder injury and let you know whether you have disrupted your AC joint, subluxed your shoulder, damaged your rotator cuff, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Pallis, M., Cameron, K. L., Svoboda, S. J., & Owens, B. D. (2012). Epidemiology of acromioclavicular joint injury in young athletes. The American journal of sports medicine, 40(9), 2072-2077.
de Groot, C., Verstift, D. E., Heisen, J., van Deurzen, D. F., & van den Bekerom, M. P. (2023). Management of acromioclavicular injuries–current concepts. Orthopedic Research and Reviews, 1-12.

Low Back - Lumbar Spine Osteoarthritis

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 20 Jun 2025 04:51:06 GMT

Over a lifetime, the low back gets a fair workout. Osteoarthritis is part of the journey.

Try these low impact exercises for mild low back pain.

One of the joys (or consequences) of aging is the development of some degree of degeneration in our joints. Known as osteoarthritis, or OA, this type of joint degeneration is common and, to a large extent, the result of a lifetime of moving. The degree to which OA develops varies from person to person and joint to joint, and the reasons for its development are complex, variable, and individual.

Our low back, known as the lumbar spine, is no exemption. Over a lifetime, the lower back gets a fair work out. From lifting a couch into a new house, to absorbing the landing impact at football, to supporting us while we sit through a movie marathon, our backs don’t get a lot of rest. It’s no wonder they get a little worn out over time.

Anatomy 101 – Bear with me, it’s important.

If you want to understand lumbar osteoarthritis better, you need a little bit of knowledge of the anatomy. It helps to have a good picture available while you do this, so we’ve put this information alongside a top-notch picture. Click here for lumbar spine anatomy 101.

What the Lumbar Spine does, and why it can break down.

The primary role of the lumbar spine is absorption and distribution of load and movement in flexion and extension. This movement occurs at the intervertebral disc and the direction of movement is guided and dictated by the orientation of the facet joints.

The lumbar disc is, quite frankly, awesome in its design and ability to absorb and distribute forces.

The facet joints too are pretty nifty structures. They have a super-smooth layer of cartilage on them that allows for frictionless gliding and protects the underlying bone. But they’re not infallible. Over time, due to a range of factors including repetitive use or trauma, age, gender and genetics, the cartilage can break down, exposing the bone underneath to loads its not designed for, resulting in inflammation of the joint and joint capsule, restricted movement, pain, and loss of function.

This, my friend, is osteoarthritis. The term itself is Latin and means bone (osteo), joint (arthro), inflammation (itis). While OA can affect any synovial joint in the body, the lumbar spine is particularly susceptible and has been linked to the high prevalence of back pain in aging populations. Given that the population generally is getting older (because we are living longer), it makes sense that we explore ways to manage this health problem.

What is it with this back pain?

Lumbar OA usually has a slow, insidious onset. This just means that there is often no identifiable incident that brought on symptoms. People often present with generalised lower back pain, ache, or discomfort. Pain will often be referred into the buttocks, and patients may report back stiffness, particularly in the first few hours of the day after rising or after sitting for prolonged periods.

Because onset is gradual over time, many people don’t seek assistance from a physiotherapist until symptoms are significantly limiting their daily activities.

As a result, range of available movement can be quite restricted and strength deficits present, impacting normal daily activities, hobbys and pursuits.

What’s next? Xrays? Surgery?

This will depend on a range of factors such as the duration and severity of symptoms, your age, and impact on work and daily activities.

Xrays and MRI’s are pretty commonly undertaken but often they don't add a lot of information to the clinical picture. It's important that we use these resources judiciously, and when used that the findings from these be interpreted carefully and with due consideration of presenting symptoms.

Keep in mind that about 80% of people over the age of 50 will have osteoarthritic changes on lumbar xray regardless of whether they have symptoms or not.

Surgery is reserved for severe cases, usually only when nerve root compression is present and there is associated neural symptoms.

What to do, what to do?

The good new is that, in the majority of cases, there is a lot that physiotherapy can do to assist with lumbar osteoarthritis. While we don’t have a cure for OA, the evidence unequivocally points to exercise as the best medicine for managing symptoms such as reduced functional strength and loss of range of movement.

Symptoms from lumbar OA will vary over time. A prudent management plan will be multi-disciplinary (including your GP and specialist if required) and include therapeutic exercises (pop your details in at the top of this page and get started today), targeted manual therapy, joint mobilisation and soft tissue therapy. This approach has been shown to be extremely effective at managing symptoms and restoring functional activity. Additionally, hydrotherapy , pilates and massage therapy all have a place in the treatment and management plan for managing lumbar osteoarthritis.

The Take Home

Low back osteoarthritis is a consequence of living longer. Most people will at some point experience low back pain associated with OA. Left untreated, it can be debilitating. With a little consideration and planning, low back OA can be effectively managed, allowing many people to continue to live active, fulfilling lives.

Got low back pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your low back pain and let you know whether you have osteoarthritis, discogenic back pain, or sciatica, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Ackerman, I. N., Buchbinder, R., & March, L. (2023). Global Burden of Disease Study 2019: an opportunity to understand the growing prevalence and impact of hip, knee, hand and other osteoarthritis in Australia. Internal medicine journal, 53(10), 1875-1882.
Borenstein, D. (2004). Does osteoarthritis of the lumbar spine cause chronic low back pain?. Current pain and headache reports, 8, 512-517.
Brand, C. A., Harrison, C., Tropea, J., Hinman, R. S., Britt, H., & Bennell, K. (2014). Management of osteoarthritis in general practice in Australia. Arthritis care & research, 66(4), 551-558.
Goode, A. P., Carey, T. S., & Jordan, J. M. (2013). Low back pain and lumbar spine osteoarthritis: how are they related?. Current rheumatology reports, 15, 1-8.
Guven, A. E., Schönnagel, L., Camino-Willhuber, G., et al. (2024). Relationship between facet joint osteoarthritis and lumbar paraspinal muscle atrophy: a cross-sectional study. Journal of Neurosurgery: Spine, 1(aop), 1-9.
Kalichman, L., & Hunter, D. J. (2007, October). Lumbar facet joint osteoarthritis: a review. In Seminars in arthritis and rheumatism (Vol. 37, No. 2, pp. 69-80). WB Saunders.
Physiopedia (2025). https://www.physio-pedia.com/Spinal_Osteoarthritis

The Foot - Turf Toe

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 20 Jun 2025 02:38:10 GMT

Turf toe is more than just a sprain – It’s a debilitating injury that can severely limit function without the right management.

Try these low impact exercises for mild turf toe

Turf toe often gets dismissed as a minor issue — “just a toe sprain” — but it can seriously affect your ability to walk, run, jump or change direction. The big toe plays a crucial role in stability and propulsion. Without proper diagnosis and rehabilitation, turf toe can become a chronic issue that limits performance and function.

Anatomy 101

The big toe joint, called the first MTP joint , is where the long bone in your foot meets the base of your big toe. This joint is supported by strong tissues, including ligaments, a tough capsule, and small bones under the toe called sesamoids. These parts work together to support your toe, especially when you bend it upwards. If too much force or pressure is placed on the toe, like during running or sudden stops, these tissues can get overstretched or torn. This type of injury is commonly known as “turf toe.”

Who gets it?

Turf toe is commonly seen in athletes playing on artificial turf, hence the name. Sports involving rapid acceleration, cutting, and contact (e.g., football, rugby, hockey, dance) put players at higher risk.
Common mechanisms of injury include:

Contact injury – Another player lands on the back of the foot, forcing the toe into hyperextension.
Non-contact injury – A sudden push-off or a change in direction causes the toe to jam into the ground, as can occur when changing direction from running backwards to running forwards.

Grading & severity of Turf Toe:

Severity of injury exists on a continuum, with Grade I being a “stretching” of the soft tissues underneath the toe, Grade II being “partially torn” soft tissues, and Grade III involves complete tearing and may include associated injuries such as fractures, joint dislocation, sesamoid fracture, or a plantar plate rupture.

Symptoms of Turf Toe

Symptoms can vary depending on severity, but the following signs should prompt a closer look

Pain at base of the big toe
Aggravated during push-off with walking, running or jumping
Swelling and bruising around the big toe
Restricted motion and loss of strength
In severe cases, instability or visible deformity

Diagnosis and injury grading

Your physiotherapist can diagnose turf toe with a thorough clinical assessment , including history and physical examination. Key diagnostic clues that can help confirm a diagnosis.

Mechanism of Injury (hyperextension)
Location of pain and swelling
Joint laxity or instability
Reduced Push-off strength and pain

Turf toe injuries are graded according to presenting signs and symptoms.

Grade 1: “stretching”

Mild localized tenderness
Mild swelling
No bruising
No Instability
Able to weight bear

G rade 2: “Partial Tear”.

Diffuse, widespread tenderness
Moderate swelling
Bruising
Limited Range of movement
Difficulty weight bearing, particularly in later stance phase

Grade 3: “Complete Rupture”

Severe tenderness
Significant swelling
Pronounced loss of movement
Frank instability
Unable to weight bear

Do I need imaging?

Most cases don’t require imaging, but your physiotherapist will use clinical judgement to determine if a more serious injury is present. The physiotherapist may recommend an X-Ray or MRI if there is concern for:

Fractures
Complete Ligament Tears
Significant Joint Instability
Sesamoid Injuries

Treatment

Management depends on the time frame that's elapsed since injury and presenting to physiotherapy, the grade of injury, current functional limitations, and the specific goals and requirements of the individual. Regardless of the severity of the injury, rehabilitation will include the following components.

Period of Immobilisation (taping, toe splint, orthotics, possibly a boot for more severe injuries)
Joint mobilisation to regain normal range of motion (especially toe extension)
Calf and foot strengthening
Proprioceptive training (e.g., balance drills)
Sport-specific return to play reconditioning

Surgical Intervention

Fewer than 2% of turf toe injuries require surgery. However, in high-level athletes or in cases where conservative treatment fails, surgery may be needed to restore joint stability. Surgical repair may involve soft tissue reconstruction, fixation of the sesamoids or plantar plate.

How long is it going to take?

99% of Grade 1 and Grade 2 injuries recover well with conservative treatment provided they get appropriate physiotherapy intervention and a comprehensive rehabilitation program to restore big toe strength to allow a return to previous level of performance. Grade 3 injuries may take longer, and many never fully regain previous levels of performance without a structured rehabilitation plan.

As a guide, Grade 1 injuries take 1-2 weeks, Grade 2 injuries 3-6 weeks, while Grade 3 injuries can take 3 or more months to recover depending on the need for surgery.

The Take Home

Turf toe may sound minor, but when mismanaged it can become a chronic, debilitating issue that affects push-off, balance, and performance. Early diagnosis and structured rehabilitation are essential to prevent long term complications.

Got toe pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your toe pain and let you know whether you have turf toe, a toe fracture, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Gupta, A., Singh, P. K., Xu, A. L., Bronheim, R. S., McDaniel, C. M., & Aiyer, A. A. (2023). Turf Toe Injuries in the Athlete: an Updated Review of Treatment Options, Rehabilitation Protocols, and Return-to-Play Outcomes. Current reviews in musculoskeletal medicine, 16(11), 563–574. https://doi.org/10.1007/s12178-023-09870-y
Vopat, M. L., Hassan, M., Poppe, T., Tarakemeh, A., Zackula, R., Mulcahey, M. K., Mullen, S., Burkholder, R., Schroeppel, J. P., & Vopat, B. G. (2019). Return to Sport After Turf Toe Injuries: A Systematic Review and Meta-analysis. Orthopaedic journal of sports medicine, 7(10), 2325967119875133. https://doi.org/10.1177/2325967119875133
Limaye, N., Sethi, M., & Ayyaswamy, B. (2024). Outcomes of Surgical Management of Turf Toe: 12-Year Results. Cureus, 16(4), e57808. https://doi.org/10.7759/cureus.57808

The Wrist - Triangular Fibrocartilage Complex Injuries

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 15 May 2025 05:09:00 GMT

Triangular fibrocartilage complex injuries require careful, considered, individualised management.

Try these low impact exercises for mild wrist pain

Triangular Fibrocartilage Complex (TFCC) injuries are a common cause of wrist pain particularly in sports that place high stress loads on the joint, for example gymnastics, tennis and weightlifting. It is a painful injury that impacts everyday function and participation in sport.

What Is the TFCC?

The Triangular Fibrocartilage Complex (TFCC) is a group of ligaments and cartilage structures located on the ulnar (pinky finger) side of the wrist. It serves a crucial role by:

Stabilizing the joint
Supporting load bearing across the wrist, especially during gripping and twisting.
Cushioning and stabilizing the small bones of the wrist during motion.

Think of the TFCC as a shock absorber for your wrist, especially during movements

that involve rotation or pressure.

The central part of the TFCC has an important blood supply. Injury to this aspect of the TFCC can disrupt the blood supply as well as destabilize the wrist joint, requiring careful planned management, often involving multidisciplinary health professionals to achieve optimal outcomes.

Who gets it?

TFCC injuries are common in gymnasts, tennis players, weightlifters, boxers, pole vaulters and hockey players either because of an acute injury or repetitive overload resulting in degenerative tears. For some people, there is a genetic component where the structure and alignment of the TFCC and the surrounding bones can make you more susceptible to this injury.

TFCC injuries are frequently missed after a fall onto an outstretched hand. In fact, between

35 and 70% of people who fracture their wrist also have a TFCC injury.

Common Causes of TFCC Injuries

TFCC injuries typically happen in two ways:

1. Traumatic Injury. This is often the result of:

A fall onto an outstretched hand
A sudden twisting motion of the wrist or forearm
Lifting something heavy with a twisting grip

2. Degenerative Injury. Over time, the TFCC can wear down due to:

Repetitive wrist use (e.g., in tennis, gymnastics, or manual labour)
Age-related degeneration
An anatomical mismatch (e.g., ulnar variance – when the ulna is longer than the radius)

Symptoms of a TFCC Injury

Symptoms can vary based on the severity of the injury, but common signs include:

Pain on the ulnar (pinky finger) side of wrist that is particularly aggravated by gripping, twisting and putting weight through your hand.
Clicking or popping during movement.
Weakness when gripping or twisting objects.
Swelling or tenderness around the ulnar side of the wrist.
Decreased range of motion due to pain or stiffness.

Diagnosis

Physiotherapists are experts in the assessment and diagnosis of musculoskeletal injuries like this. Your physiotherapist will enquire as to the history of your wrist pain, the types of activities you frequently do, what aggravates your pain and how it behaves on a daily basis to determine if it could be a TFCC injury or something else.

A physical examination follows and will consist of palpation of structures to assess for pain and instability in joints around the hand and wrist, assess of movement and strength of your wrist, and a range of special tests for different structures in the hand and wrist, including the TFCC, to see if an injury to a specific structure has occurred. In addition to this, your physiotherapist may assess activities that are relevant to your goals and presentation such as sport specific activities.

Do I need imaging?

In most instances, where a TFCC injury is suspected, imaging is required as this can assist in directing treatment.

Initially X-rays are taken to rule out fractures. This is particularly important with a history of acute injury, such as a FOOSH .

Ultrasound can assist in identifying TFCC tears and their location within the TFCC.

In complex or recalcitrant cases, and where surgery is being considered, MRI or MR arthrogram can be taken for detailed views of soft tissue.

Treatment Options

Non-Surgical Management

Most TFCC injuries can be managed conservatively if no instability is present. Non-surgical management involves:

Rest and activity modification: this will consist of a period of not weight bearing through your wrist along with some time off sport.
Wrist splinting or bracing for 6 weeks to allow for structural healing.
Anti-inflammatory medications (NSAIDs) may be prescribed by your GP or pharmacist to help manage symptoms.
Taping to support alignment during healing and reduce pain.
Stabilising and strengthening exercises
Sport specific drills and exercises with a gradual return to sport program.

Surgical Intervention

If the severity of the tear is causing instability AND/OR central TFCC blood flow has been affected OR the injury fails to resolve with conservative management, surgery may be necessary:

Arthroscopic debridement: Removing damaged tissue
TFCC repair: Suturing the tear, especially for peripheral injuries
Ulnar shortening osteotomy: For ulnar-positive variance that contributes to chronic TFCC problems

Recovery and Rehabilitation

Return to activity/sport timeframes will vary depending on the type of activity and the demand placed on the wrist. Importantly, rehabilitation and return to sport/activity must be individualised and carefully progressed based on clinical findings, signs and symptoms.

Typically, sports involving repetitive movements such as tennis may return with aid of bracing/taping in 6-8 weeks while sports involving high loads such as gymnastics may require 8-12 weeks to return to competition.

Surgery will generally be considered earlier in the management pathway if a tear is present in the central component of the TFCC as these injuries tend to result in unacceptable wrist joint instability and disruption of blood supply. Post-surgical recovery may take 3 to 6 months

Due to the complexity of the structures and the vital role the TFCC plays in wrist function, in the absence of a central tear or instability of the TFCC, evidence suggests up to 6 months of conservative rehabilitation should be undertaken prior to considering the need for surgery.

Prevention Tips

While it’s not possible to eliminate all risk associated with TFCC injuries, there are some things you can do to reduce your chances of this injury, particularly degenerative tears.

Avoid repetitive wrist strain and sudden torque-like movements. If your sport does require repetitive wrist movements under load, then make sure there are adequate recovery periods and cross train to give your wrist joints some rest.
Strengthen forearm and wrist muscles to provide joint support.
Modify techniques in sports or work to reduce ulnar-sided loading.

Your physiotherapist understands these intricately and can work with you and your coaches or workplace to implement sustainable changes to reduce your injury risk and improve performance.

The Take Home

TFCC injuries require careful, considered, individualised management. Failure to respect the location and severity of this injury can have long term implications for wrist joint stability and function and have an impact on daily life, sport and work. The evidence suggests that early assessment and treatment by a qualified healthcare professional is important to plan appropriate management and allow for healing and recovery without the need for surgery.

Got wrist pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your wrist pain and let you know whether you have a TFCC injury, a wrist fracture, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

OrthoBullets. (n.d.). Triangular fibrocartilage complex (TFCC) injury. Retrieved May 12, 2025, from https://www.orthobullets.com/hand/6047/triangular-fibrocartilage-complex-tfcc-injury
Physio-pedia. (n.d.). Triangular fibrocartilage complex injuries. Retrieved May 12, 2025, from https://www.physio-pedia.com/Triangular_Fibrocartilage_Complex_Injuries
Physiotec. (n.d.). TFCC injury and wrist pain: Symptoms, diagnosis & treatments. Retrieved May 12, 2025, from https://www.physiotec.com.au/tfcc-injury-and-wrist-pain-symptoms-diagnosis-treatments/
Sports Injury Clinic. (n.d.). TFCC tear. Retrieved May 12, 2025, from https://www.sportsinjuryclinic.net/sport-injuries/wrist-pain/acute-wrist-injuries/tfcc-tear
Golden-Hart, A. L., Romero, J. M., Kakar, S., Vilai, P., Kannas, S., Salinas-Alvarez, Y., ... & Boettcher, B. J. (2024). Evaluation and Management of Triangular Fibrocartilage Complex (TFCC) Injuries in the Athlete. Current Physical Medicine and Rehabilitation Reports, 12(3), 276-286.
Wu, W. T., Chang, K. V., Mezian, K., Naňka, O., Yang, Y. C., Hsu, Y. C., Hsu, P. C., & Özçakar, L. (2019). Ulnar Wrist Pain Revisited: Ultrasound Diagnosis and Guided Injection for Triangular Fibrocartilage Complex Injuries. Journal of clinical medicine, 8(10), 1540. https://doi.org/10.3390/jcm8101540

Discogenic low back pain

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 24 Feb 2025 03:08:17 GMT

Discogenic low back pain is a common cause of chronic low back pain that responds well to multi-modal intervention.

Try these low impact exercises for mild subacute low back pain

Discogenic low back pain is a common cause of chronic low back pain (LBP) , attributed to degeneration, inflammation, or injury of the intervertebral discs in the lumbar spine. It is a significant public health issue due to its high prevalence, economic burden, and impact on quality of life. Caused by disruption to the outer part of the intervertebral disc, discogenic low back pain can be painful and debilitating.

Evidence suggests that with early conservative treatment, most people make a full recovery and return to normal daily living.

Anatomy 101

The lumbar spine consists of five lumbar vertebrae, intervertebral (IV) discs, and numerous supporting ligaments and muscles. The intervertebral disc, located between each vertebral body, plays a crucial role in the spine by acting as a shock absorber and providing flexibility and stability to the vertebral column. As muscles contract and apply force to the vertebra, the disc conforms to allow movement. For example, with forward flexion, the IV disc is compressed at the front and stretched at the back (a bit like a vanilla slice when you gently press down on one side).

IV discs are comprised of an inner nucleus that is made up of a gel-like substance, surrounded by layers of cartilage called the annulus fibrosis. The nucleus is mobile and shifts within the disc depending on the direction of force. This structure allows the disc to absorb axial load and permit controlled movement in three dimensions.

What causes discogenic low back pain?

Discogenic low back pain occurs along a continuum from inflammation of the disc to stress responses in the outer part of the annulus fibrosis, to fissuring (or splitting) of the annulus fibrosis, and finally herniation of the nucleus through the annulus into a closed space (either the spinal canal or the nerve root canal).

While acute injuries can result in discogenic low back pain, the most common cause is from sustained periods in lumbar flexion or repetitive lumbar flexion exposure over time that exceeds the load capacity and recovery properties of the annulus fibrosis. These actions can disrupt fibers and result in structure breakdown and related symptoms.

The annulus fibrosis is highly innervated (has lots of nerve supply), so when it gets stretched beyond its normal capacity or fissures the inflammatory response causes pain. In response, muscles spasm to protect the area, which is great at limiting movement but can cause additional discomfort. If the bulge or herniated nucleus compresses spinal nerves or the spinal cord, then this can cause further pain, and, in some instances, altered sensation and motor function.

Who gets it?

Discogenic low back pain is common, accounting for 39-50% of all chronic low back pain presentations. It is more common in people aged 20-50 years, occurs in men more than women, and is more common in persons with a family history of discogenic low back pain. In older populations, discogenic low back pain is more likely due to annular tears or disc inflammation than from herniation (the nucleus becomes dehydrated and less mobile with age and therefore unlikely to herniate).

Extrinsic (or modifiable) risk factors include smoking, occupation and lifestyle (including some sports and work duties with repetitive lumbar flexion), obesity, physical inactivity and previous spinal injury. These factors form an important component of best-practice management of low back pain.

Diagnosing discogenic low back pain

Discogenic low back pain can be diagnosed clinically by a physiotherapist. A thorough interview and clinical assessment of the person with discogenic low back pain will often reveal common signs and symptoms of deep, localized low back pain aggravated mostly by forward bending and sitting and eased with walking and standing. Dull or shooting pain may radiate into the buttock or as far as the knee. If disc herniation is compressing a nerve root, signs and symptoms may include more distal referral of pain, altered reflexes, intermittent sensory changes (numbness or pins and needles), and muscle weakness.

There are several conditions that must be considered as part of a low back pain diagnosis as the treatment and management will differ. These include (but are not limited to) non-specific low back pain, muscle strains, scoliosis and sciatica. Importantly the presence of significant muscle weakness, changes to bowel and bladder function, or the presence of saddle paresthesia require urgent medical attention. Your physiotherapist or doctor can advise you if these symptoms are present on assessment.

Do I need a scan?

Judicious use of medical imaging can assist with treatment planning and management of discogenic low back pain, particularly where neurological symptoms are present. Research shows that x-ray and MRI findings don’t always align with symptom presentation and that disc protrusions and herniations can be asymptomatic. For this reason, medical imaging should be interpreted and communicated carefully with respect to medical history, clinical findings and normal age-related changes.

Where imaging is indicated, MRI is considered the gold standard for investigating disc degeneration, annular tears, and disc inflammation.

Treatment

Most episodes of discogenic low back pain can be effectively managed with conservative (non-surgical) treatment combining physiotherapy, pharmacological, and lifestyle changes.

There is strong evidence for the use of physiotherapy in discogenic low back pain. In the acute phase, manual therapy (including the McKenzie method) and hydrotherapy have been shown to reduce pain, improve movement patterns, and restore normal function. Over the counter pain medication such as paracetamol and non-steroidal anti-inflammatories can assist with pain management during this period (check with your doctor or pharmacist before taking). Where muscle spasm is present or where pain has persisted beyond a normal timeframe, your doctor may recommend prescription medications to assist.

As pain settles, exercise therapy should be commenced under the guidance of a physiotherapist. Programs should be tailored to the individual, and address areas of weakness and reduced range of motion. Particular attention should be given to the strength of the posterior chain, including the low back extensor muscles, gluteals and hamstrings.

Where modifiable lifestyle factors are present, these should be discussed and where indicated, addressed.

What about an injection, or surgery?

Corticosteroid injections in the epidural space can reduce inflammation and provide temporary relief, especially in cases where nerve root compression is present. There is limited evidence for long-term benefits though, and so these are typically considered for short-term relief in more severe cases of discogenic low back pain.

Surgery is typically considered only when conservative treatments fail, and symptoms are severe or debilitating.

How long’s it going to take?

The recovery time from discogenic low back pain can vary widely depending on the severity of the condition, the treatment approach, and individual factors like age, overall health, and adherence to rehabilitation strategies.

Most cases of discogenic low back pain resolve within 6-12 weeks.

If pain has persisted for greater than 4 weeks, then full recovery may take longer. Adhering to a structured rehabilitation program, maintaining a healthy lifestyle, and following up with healthcare providers can greatly improve the recovery rate and functional outcomes.

Take Home

Discogenic low back pain is a common cause of chronic low back pain, originating from intervertebral disc degeneration or injury. Effective treatment and management should be evidence-based and individualized. For most patients, conservative treatments remain the first-line management, with surgery reserved for those with severe and persistent pain that is unresponsive to conservative measures. Recovery is highly individual. Some may recover faster, while others may take longer to feel better. If pain persists, it’s important to consult with a healthcare provider to reassess and possibly adjust the treatment plan.

Got low back pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your low back pain and let you know whether you have a discogenic low back pain, non-specific back pain, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar disc herniation. Current reviews in musculoskeletal medicine, 10, 507-516.
Brukner, P. & Khan, K. (2012). Clinical sports medicine(4th ed.). Australia: McGraw-Hill.
De Simone, M., Choucha, A., Ciaglia, E., et al. (2024). Discogenic low back pain: Anatomic and pathophysiologic characterization, clinical evaluation, biomarkers, AI, and treatment options. Journal of Clinical Medicine, 13(19), 5915.
Fujii, K., Yamazaki, M., Kang, J. D., et al. (2019). Discogenic back pain: literature review of definition, diagnosis, and treatment. Journal of Bone and Mineral Research Plus, 3(5), e10180.
Jordan, J. L., Konstantinou, K., & O'Dowd, J. (2011). Herniated lumbar disc. BMJ clinical evidence, 2011.
Manchikanti, L., & Hirsch, J. A. (2015). An update on the management of chronic lumbar discogenic pain. Pain management, 5(5), 373-386.
Mohd Isa, I. L., Teoh, S. L., Mohd Nor, N. H., & Mokhtar, S. A. (2022). Discogenic low back pain: anatomy, pathophysiology and treatments of intervertebral disc degeneration. International journal of molecular sciences, 24(1), 208.
Tonosu, J., Inanami, H., Oka, H., et al. (2016). Diagnosing discogenic low back pain associated with degenerative disc disease using a medical interview. PloS one, 11(11), e0166031.
Vialle, L. R., Vialle, E. N., Henao, J. E. S., & Giraldo, G. (2010). Lumbar disc herniation. Revista Brasileira de Ortopedia (English Edition), 45(1), 17-22.

Heart Health - Recovery and Exercise after a Heart Attack

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 18 Feb 2025 01:12:36 GMT

Exercise is a cornerstone of recovery following a heart attack.

Heart attacks are frightening and can have profound physical and mental health effects on patients and their families. Ask anyone who has experienced one (or more) and they will likely tell you one of their great fears is not being able to do the things they love any more. Treatment is complex and lifelong, and involves medications, lifestyle changes and exercise. Under the guidance of your doctor and physiotherapist, therapeutic exercise can accelerate your return to normal activities, reduce your chances of another heart attack, and help you feel healthier and more energetic.

Anatomy 101

In the words of Gang of Youths , the heart is a muscle. Its main role is to circulate oxygen-rich blood throughout the body to keep the organs, muscles and tissues functioning. Consisting of two atria and two ventricles , the heart simultaneously pumps blood to the lungs to pick up the inhaled oxygen and distributes oxygen-rich blood to the rest of the body. As blood courses through the body, muscles, organs and tissues utilize oxygen for movement and bodily functions. The rhythmic beating of the heart maintains pressure in the circulatory system, helping return deoxygenated blood back to the heart where the process continues. Like all other organs, the heart has its own blood supply, the coronary arteries . If that supply is interrupted, for example due to a blockage or damage to a coronary artery, then heart muscle can be damaged resulting in a heart attack.

Who gets it?

Cardiovascular disease is a leading cause or morbidity (illness) and mortality (death) in Australia affecting 5.2% of the population. Nearly 2% of the population will experience a heart attack (an acute myocardial infarction) during their lifetime with males more at risk than females. A family history of heart disease and age over 45 (males) or 55 (females) also increases the risk of future heart disease.

Concerningly, Aboriginal and Torres Strait Islander people have a 2.4 times increased death rate from coronary heart disease than non-Indigenous Australians.

Extrinsic risk factors for heart disease (and therefore for heart attack) include diets high in saturated fat and salt, reduced physical activity, and smoking. Modifying these lifestyle factors can significantly reduce your risk of heart disease. Co-morbidities including high blood pressure, diabetes, and obesity also increase the risk of heart disease.

Diagnosing a heart attack

Heart attacks generally occur suddenly, though there are subtle signs and symptoms that may precede an actual heart attack. Symptoms of heart attack include:

Chest discomfort or pain (angina). This can feel like uncomfortable pressure, aching, numbness, squeezing, fullness or pain in your chest. This discomfort can spread to your arms, neck, jaw or back. It can last for several minutes or come and go.
Dizziness, light-headedness, feeling faint or feeling anxious
Nausea, indigestion, vomiting

Signs of heart attack include

Shortness of breath or difficulty breathing – with or without chest discomfort
Coughing and/or wheezing
Sweating or a cold sweat.

If you experience these symptoms, it is important you call 000 immediately and receive emergency care.

Treatment

Treatment and management following a heart attack follows a 4-stage process.

Immediate treatment. E mergency care is required to maintain oxygen levels, reduce pain, dilate blood vessels and address the primary cause of the heart attack. This requires pharmacological management, and often surgical procedures (eg. Insertion of a stent, or coronary artery bypass grafting) to maintain blood flow to the affected heart tissue (known as reperfusion care).
Post-Acute Care and Hospitalization. During this period various medications are prescribed to prevent further clots, manage blood pressure, and improve heart function. Patients are closely monitored for complications such as arrhythmia, heart failure, and other signs of ongoing heart problems.
Rehabilitation and lifestyle changes. Cardiac rehabilitation is a medically supervised program focusing on exercise, education, and support to help the patient recover physically and mentally. It usually includes therapeutic exercise, diet advice, and techniques to manage stress and prevent future heart attacks. Lifestyle modifications address factors that can reduce your future risk of heart attack. This might include cessation of smoking, dietary changes, reducing blood pressure and cholesterol, and physical activity.
Long-term monitoring and follow-up. Staying connected to your heart health team is important in the long term. Regular check-ups with your GP and Cardiologist can ensure medications are correctly prescribed and effective and that heart function is normal. Psychological support to address emotional health and mental well-being is vital (post-heart attack patients may experience anxiety, depression, or PTSD), while physiotherapy can help maintain physical activity and reach fitness goals over the lifespan.

Is it safe to exercise?

Following heart attack exercise should be medically guided. It is essential that you are medically stable and cleared prior to commencing exercise. Exercise should be prescribed by your physiotherapist , tailored to the individual, graded, and goal oriented. Over time, a combination of aerobic exercise and resistance training should be incorporated to improve functional capacity, physical strength, quality of life and reduce cardiac risk factors.

Daily activities play an important role in recovery from heart attack and should be considered in the overall cardiac rehabilitation program. Household chores, grocery shopping, walking the dog, and work tasks can all contribute to functional heart load and therefore be incorporated into the cardiac rehab plan.

How long’s it going to take?

Recovery following heart attack varies depending on several factors including the severity of the heart attack, emergency care required (eg. surgical v’s pharmacological management), patient age, and co-morbidities.

Broadly speaking, taking into consideration acute (hospital) management, post-acute care, cardiac rehabilitation, and lifestyle modifications, recovery can take up to 12 months, though some people may be back to work and exercising within a 3 to 6 month period.

Lifelong follow-up with your heart health team is essential to monitor heart function, manage any ongoing medications, and address any risk factors (such as high blood pressure, high cholesterol, or diabetes).

The take home

Post-heart attack treatment focuses on immediate stabilization, restoring blood flow to the heart, preventing further damage, and making long-term adjustments to lifestyle and medication. By managing risk factors, patients can significantly reduce the chance of future heart attacks and improve their quality of life.

Returning to normal activity after a heart attack can be a long and challenging process. Exercise forms a cornerstone of recovery from heart attack and future risk reduction. Exercise should be goal oriented and tailored to your needs, and be prescribed and monitored by a suitably qualified health professional who is familiar with your presenting condition and healthcare history.

Got a heart complaint or just want to improve your heart health? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Ribeiro, F., Oliveira, N. L., Silva, G., Campos, L., Miranda, F., Teixeira, M., ... & Oliveira, J. (2017). Exercise-based cardiac rehabilitation increases daily physical activity of patients following myocardial infarction: subanalysis of two randomised controlled trials. Physiotherapy, 103(1), 59-65.
https://www.heartfoundation.org.au/your-heart/heart-attack
https://www.heartresearch.com.au/recovery-and-exercising-after-a-heart-attack/
https://www.nhlbi.nih.gov/health/heart-attack/causes
Price, K. J., Gordon, B. A., Bird, S. R., & Benson, A. C. (2016). A review of guidelines for cardiac rehabilitation exercise programmes: is there an international consensus?. European journal of preventive cardiology, 23(16), 1715-1733.
Verdicchio C, Freene N, Hollings M, Maiorana A, et al. (2023) A Clinical Guide for Assessment and Prescription of Exercise and Physical Activity in Cardiac Rehabilitation. A CSANZ Position Statement. Heart Lung Circ. 24:S1443-9506(23)04214-2.
ACSM. 2017. ACSM’s Guidelines for Exercise Testing and Prescription. Tenth Ed. Lippincott Williams and Wilkins

The Knee - Pes Anserine Tendino-bursitis

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 13 Dec 2024 07:14:58 GMT

Pes Anserine bursitis is a common cause of medial knee pain in females with diabetes.

Many of us when we have knee pain immediately think of the joint. But there are lots of different structures around the knee, including muscles, ligaments, tendons and bursa that can all contribute to knee pain. Bursa and their associated tendon(s) are often overlooked as a source of irritation and a cause of pain. These small fluid-filled sacs are highly innervated (ie. they have lots of nerves) and susceptible to repetitive trauma and compression. The pes anserine bursa is one such structure, that can produce medial knee pain. As inflammation usually occurs in combination with tendinopathy, it is referred to as pes anserine tendino-bursitis (PATB).

A little bit of anatomy

Bursae are important structures that act as a buffer between a tendon and the bony surface underneath. Think of them like a thin pillow of fluid that disperses compressive forces and reduces friction between moving parts.

The pes anserine bursa is located on the medial (inside) aspect of the knee where three important muscles converge – semitendinosis (one of the hamstring muscles), gracilis (an adductor or groin muscle) and sartorius (a hip and knee flexor and rotator).

The convergence of these three muscles is known as the pes anserine, named for its resemblance to a gooses foot (in Latin, pes means “foot” and anserine “goose-like’). Just underneath the pes anserine is the bursa, which separates the tendon structure from the bone underneath.

The muscles that form the pes anserine come from three different compartments of the leg – the anterior, medial and posterior compartments. Together they provide hip stability and protect the knee against the rotation or valgus (knock-knees) stress. Changes to knee joint alignment, a sudden increase or repetitive use of these muscles, or sustained compression on the medial aspect of the knee, can irritate the tendon and bursa resulting in PATB.

Who gets it?

Overall, the incidence of PATB in an adult population is reported by various studies to be between 2.5 to 10%. PATB is more common in older females, particularly those with valgus knee deformity. Females naturally are more likely to have a wider pelvis (for childbirth), resulting in a greater angle at the knee joint ( known as the Q angle ). This places greater stress on the medial aspect of the knee and the structures supporting movement.

Diabetes is a known risk factor for PATB, while osteoarthritis and obesity are considered additional risk factors, though their role in the pathophysiology of disease is not yet understood.

Causes of PATB

One of the more common reasons PATB develops is overuse or repetitive trauma. Exposure of the medial knee joint line to repetitive load stresses the tendon. Without adequate recovery periods this can cause pathological changes to the tendon complex, including the bursa.

Activities such as running on hard surfaces, walking uphill and /or downhill regularly, repetitive squatting, or sports that require running and change of direction can all contribute to the development of PATB.

Other contributing factors to PATB can include:

Injury or direct trauma- a fall or direct blow to the medial side of the knee can cause localised trauma that proceeds to PATB.
Biomechanical and/or developmental changes - malalignment of the knee joint producing a greater Q angle, or muscle imbalance resulting in reduced knee joint motion control can increase load and stress on the medial aspect of the knee.
Poor footwear – while empirical evidence linking foot posture and control to PATB is lacking, altered foot posture and control is known to influence knee joint biomechanics. Anecdotally this has contributed to symptoms of PATB.

Diagnosing PATB

PATB is a clinical diagnosis that can be made by a physiotherapist.

People with PATB will often describe difficulty ascending and descending stairs, pain when walking for longer distances, pain when pivoting on the affected leg, and difficulty getting up from a sitting or lying position. Swelling, pain and tenderness on palpation are other indicators of pes anserinus tendino-bursitis.

PATB shares symptoms with a number of other conditions such as medial meniscal injury , medial collateral ligament injury and patellofemoral pain syndrome , and often co-exists with knee joint osteoarthritis , so make sure you get your knee pain assessed by a qualified health professional.

Do I need a scan?

Medical imaging is not usually required to diagnose PATB. In recalcitrant cases, or where other pathology is being considered, ultrasound or MRI can be useful.

Treatment and management of PATB

PATB can usually be effectively managed with a course of physiotherapy. Initial management should be aimed at education and goal setting. Identifying modifiable risk factors and addressing these will assist in reducing symptoms and pain - things like reducing walking speed or distance, altering exercise type and cross training.

Early soft tissue and manual therapy in the first 2-3 weeks can be helpful to settle pain, particularly in the presence of co-morbidities such as knee osteoarthritis.

Exercise therapy is an important component in the treatment and management of PATB. Given the right load/recovery environment, tendon will respond by increasing tensile strength and resilience. If all load is removed, then the tendon simply adapts to this new environment by getting thinner and weaker. Not ideal!

A tailored, progressive, therapeutic exercise program will help keep the tendon healthy while pain subsides, and have the tendon primed and ready to receive load when able. This is crucial to the individual getting back to activity and pursuing their original goals.

Wholistic client-centred treatment will include advice on braces and supports and foot orthotics where indicated, and support for lifestyle modifications such as weight loss.

Can I get an injection?

Ultrasound guided intra-bursal corticosteroid injections have been shown to have good short-term effects on pain in about 70% of cases. However, studies comparing the long-term outcomes of CSI versus physiotherapy delivered exercise and education show no significant difference between groups for pain and function at 8 weeks.

CSI is known to detrimentally effect tendon structure, causing breakdown of the tendon matrix and reducing is load bearing capacity. It does not circumvent the need to address modifiable risk factors or to undertake therapeutic exercise. Thus, CSI is not recommended other than in recalcitrant cases.

How long’s it going to take?

The earlier PATB is diagnosed and intervention commenced, the better outcome. Recovery depends on the number of non-modifiable and modifiable risk factors present, the duration and severity of symptoms, and compliance with education and exercise program. In most instances symptoms can be settled within 3-6 weeks, with graded return to full activity taking 3-6 months.

Take home Advice

PATB is a common cause of medial knee pain, particularly in older diabetic females. It can be well managed by your physiotherapist with a wholistic approach covering load management, therapeutic exercise and education. Symptoms can take up to 6 weeks to settle, with most people making a full recovery and returning to pre-injury activity with no further symptoms.

Got knee pain and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess, diagnose, and treat your knee pain. We provide education and evidence-based advice coupled with a comprehensive treatment plan to help get you back to the things you love doing sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Alvarez-Nemegyei, J., 2007. Risk factors for pes anserinus tendinitis/bursitis syndrome: a case control study. JCR: Journal of Clinical Rheumatology, 13(2), pp.63-65.
Curtis, B. R., Huang, B. K., Pathria, M. N., Resnick, D. L., & Smitaman, E. (2019). Pes anserinus: anatomy and pathology of native and harvested tendons. American Journal of Roentgenology, 213(5), 1107-1116.
Farsad, F., Moghimi, J., Mirmohammadkhani, M., Gholami, E., & Moazeni, M. (2023). The Effect of Modifying the Sitting and Getting up Method on Pain Intensity in Patients with Pes anserine tendinitis bursitis: A Randomized Clinical Trial Study.
Gouda, W., Abbas, A. S., Abdel-Aziz, T. M., Shoaeir, M. Z., Ahmed, W., Moshrif, A., ... & Kamal, M. (2023). Comparing the Efficacy of Local Corticosteroid Injection, Platelet‐Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study. Advances in Orthopedics, 2023(1), 5545520.
Helfenstein Jr, M. and Kuromoto, J., 2010. Anserine syndrome. Revista brasileira de reumatologia, 50, pp.313-327.
Patil, A., Dass, B., Hotwani, R., Kulkarni, C. A., Naqvi, W. M., & Wadhokar, O. C. The Bio-mechanical correction exercises in pes anserine bursitis. Knee, 2, 5.
Saggini, R., Di Stefano, A., Dodaj, I., Scarcello, L., & Bellomo, R. G. (2015). Pes anserine bursitis in symptomatic osteoarthritis patients: a mesotherapy treatment study. The Journal of Alternative and Complementary Medicine, 21(8), 480-484.
Sarifakioglu, B., Afsar, S.I., Yalbuzdag, S.A., Ustaömer, K. and Bayramoğlu, M., 2016. Comparison of the efficacy of physical therapy and corticosteroid injection in the treatment of pes anserine tendino-bursitis. Journal of Physical Therapy Science, 28(7), pp.1993-1997.

Festive Season Exercise

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 12 Dec 2024 02:11:08 GMT

Find the balance between rest and exercise this festive season.

‘tis the season to be jolly.

For many of us it’s can also be the season for overindulgence. Christmas, and festive season celebrations, seem to start earlier every year. Christmas parties, catch-ups with friends, and family eating marathons that feel like they can (and do) go on for days. All that socialising can leave little time for our normal exercise routines, which may be a good thing. Read on.

The benefits of a rest week

At year’s end, we often need some time to wind down, reconnect with friends and family, and take a break from exercise. This can be great for our physical and mental health, allowing time to recharge, relax, and refocus. We can forget the hustle and bustle of everyday life, slow down and fill up on good food and drink.

Physically, a break from our normal exercise routine can help with recovery and injury prevention.

The reduction in load can allow muscles and joints to recover from potentially prolonged stress, to ease aches and pains that may have developed, and let some healing proceed. In the long-term, this can reduce future risk of injury and time lost to sport.

Continuous training results in elevated cortisol levels which can impact mood and mental health.

Mentally, the break away from routine and commitments can be refreshing and help us gain perspective. A relaxed approach to daily routine and diet can be rejuvenating, lowering cortisol levels and contributing to a reduction in stress and anxiety and improved mood.

If the summer months are your off-season, the Christmas period can be a good time to goal set and plan training blocks in the coming months, such as pre-season, in-season and post-season training.

Will I lose fitness if I take a week off at Christmas?

Most people will not notice a reduction in fitness from a short break. In fact, evidence suggests that taking a break and getting some rest can improve performance and recovery. These aspects can be just as important as performance, preventing burnout and reducing future injury risk.

Most active people find it hard to just stop, so chances are you will continue to undertake plenty of incidental activity – walking after meals, going to the park with the kids, playing in the pool, maybe some backyard cricket. All of this activity contributes to load on muscles and joints and negates some of the potential fitness loss. Either way, even if there is a slight reduction in fitness, most people will return to their previous fitness levels quickly once regular training resumes.

Adjusting your workout routine at Christmas

If you don’t want to take a full week off over Christmas or are looking at using this time to establish a routine to take into the new year, consider a simple home-based program or alternative routine so you can spend more time with family. Activities such as stretching, yoga, pilates, walking, pool-based exercise or slow cycling promote rest and recovery and are highly beneficial. Adjusting the focus from performance to recovery during this week means we start the new year feeling fresh, recovered, and ready to go.

It’s okay to keep training over Christmas

Let’s be honest. Exercise is a great way to manage mental (and physical) health, and some people just need the routine or an excuse to escape the trappings of Christmas. If this is you, or if you have an upcoming event that requires regular training, then stick to your routine. Recovery and rest periods can be factored in at other times.

Nutrition at Christmas

Part of Christmas for many people is the opportunity to have a great time and enjoy all the good food and drink on offer. With so much choice, it can be easy to overdo it. How you approach this period is completely up to you, and we suggest that if training is on the backburner, then relax and enjoy.

If you tend to overdo it and want to try and avoid this, here are some simple tips:
Eat mindfully. Try to slow your eating down, savour each mouthful, and avoid distractions while you’re eating.
If you tend to fill your plate, use a smaller plate
Take your time and let your meal settle before heading back for seconds
Plan ahead on how you can use leftovers in future meals
Drink plenty of water and enjoy alcohol in moderation.

Starting again in the new year

A benefit of keeping some exercise going over the festive period is that it can physically and mentally easier to get back into a routine after it. Typically after a break, we feel a little slower (and heavier), which can impact motivation. In reality our weight and strength won’t have significantly changed, but the association between reduction in exercise and increase in consumption will make it feel like it!

The key to getting back into exercise routine is to start back slowly and gradually build up to your desired training level. Don’t expect to be at the same level as prior to the break. Whilst you won’t have “lost” fitness, you will still need time to get used to things again. Rest assured muscle memory will kick in and you’ll be back up and running before you know it.

The Take Home

It’s Christmas. Enjoy what’s on offer and treat yourself a little. No matter what your goals are, rest and relaxation are a vital component of any training regime. Without rest, our body cannot recover and fully implement the benefits of our training. Use this time to let your body rest and recover, to mentally recharge and refocus on your future goals. Want to keep exercising? Consider changing things up so that your body still has time to unwind and you can spend valuable time with family and friends.

Do you want to improve your fitness and reduce your injury risk? Give us a call.

At Movement for Life Physiotherapy, we are as much about injury prevention as we are treatment and management. We love our sport and can work with you and your coaches to tailor an off-season program to meet your individual needs.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Maintaining Fitness in the Off-season

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 03 Dec 2024 11:09:30 GMT

A little planning can minimise loss of fitness during the off-season.

Back in January, you vowed to get fitter. Another season of sport was just around the corner, and rather than going in under prepared and risking another hammy strain (two in the past three years), you would start running sooner, maybe throw in some regular sprint sessions (keen!) and swing around those kettle bells you got for Christmas.

The rains were tumbling down, you had some holidays booked and then work was busy. Time seemed to fly by. Before you knew it, pre-season was underway, and games started in a month.

No worries, you thought. I’m onto it. Four weeks is plenty of time.

You got to two of the pre-season sessions and threw in an extra run each week. Still, by the time you hit the track you were blowing worse than old Uncle Merv, and he’s been a pack-a-day smoker for 40 years.

All good, I’ll take the first few games easy, use it as some extra pre-season training. Game one went well, you got the win, and even though you pulled up a little sore (bloody DOMS ), you were pumped.

Week two came around, skills were back, you were leading strong, and then POP. There goes the hammy. Not the one you did last year, the other one. Damn.

Sound familiar?

The off season can be hard to stay motivated. After a gruelling season of sport, we need a rest and break from the rigours of sport to freshen up both physical and mentally. The goal is to achieve this while not losing all the physical gains from the previous season. Believe it or not, our bodies really do like some regular load exposure. In fact, most of our tissues thrive on it. So how does the off season differ from pre-season and in-season training, and how do we manage the off-season to ensure we’re ready to tackle the pre-season when it comes knocking in a few months’ time?

Pre-Season Training

Preseason training is a period of progressive overload sessions that occur prior to the commencement of a new season. They are designed to condition the athlete for the physical requirements of the next season and prepare them for the demands and skills of the game. A well designed and adequate preseason will cover aerobic and anaerobic work, strength, and speed, lifting your fitness levels to new heights. It can also reduce injury risk. Read more about pre-season training here .

In-Season Training

During the season, training is often sport-specific and focussed on the key attributes of the sport. If you play an endurance-based sport, like hockey or soccer, then training will necessitate plenty of running and skills work and perhaps some routine strength sessions (if not, you should, it makes a massive difference). If you’re a cyclist, you’ll do plenty of riding. This routine is important for keeping the body ‘fit for purpose’ so to speak. It can be gruelling, both physically and mentally, managing training timing and load to ensure you are in peak condition for each event or game, while honing your skills so you can execute repeatedly to a satisfying level.

Phew. No wonder we feel like a few beers in the off season.

Off-season training

Off-season training is all about letting your body and mind recover, minimising loss of fitness, and addressing pains and niggles that have arisen over the previous season.

At the end of a season or big competition, take a few weeks to unwind. When you do start thinking about training again, change it up.

Why? Following the same routine during the off-season for other training phases has a few issues:

It can become monotonous and mentally fatiguing, which can seriously impact motivation.
You can increase your risk of overuse injuries by not allowing some opportunity for tissues to repair and recover from the demands of the season.
You can train yourself into an injury by not correcting pre-existing muscle imbalances or biomechanical issues.

So how do you change things for the off-season, reduce your injury risk AND keep it interesting?

The key to an effective off-season period is planning and thinking outside the normal routine.

First up, if you think you have nothing to work on in the off-season, get some advice. Your coach will be able to advise what physical attributes you need to work on. If you have had a run of injuries, or been pulling up sore from games, see your physio first, as they can help identify causes and set out an effective exercise plan that ticks all the boxes.

Address Deficiencies. The off-season is the perfect chance to address some of the deficiencies from the previous season. For instance, maybe you found it hard to run out a game or repeat sprint efforts were hard. Pulling up sore after every game? Some additional strength work might be required
Had an injury? While you may have made a full return to sport, there are likely to be some ongoing issues present that need to be worked on. For instance, if you’ve had a hamstring strain , then you might have some persistent muscle imbalances, muscle tightness, neural tightness or gluteal weakness that is increasing your risk of a future strain. The off-season is the perfect time to address these.
Upskill in other areas. Modifying your training can allow some muscle groups and joints to recover, while expose underutilised areas of the body to some load and adaptation. This can sharpen up other skills, such as agility, power, balance and coordination.
Cross train. The off-season is a great time to explore different training options. Getting on the bike or doing some swimming can be great for upping your cardiovascular fitness, while cross fit or circuit classes will strengthen other parts of the body. A simple body resistance program you can do at home is perfect in the wet season when getting outdoors can be a little challenging. A program like this can be a great place to start.
Explore other sports. Picking up a different sport during the off-season can be a great way to challenge your fitness and physical competencies. Squash, tennis, basketball and indoor hockey (if they are not your main sport) are great for fitness, agility and speed, while martial arts or yoga are great for balance, control and mind body awareness. New sports are also a good opportunity to meet new people and stay socially engaged, which can help with…motivation.

Staying motivated

For many, this is the hardest part, particularly for the weekend warriors out there. Despite best intentions, life gets busy and too often our exercise commitments are the first to go. So how do you stay motivated and on track? Here are some simple tips to get your off-season training humming along.

Set SMART goals. S pecific. Measurable. Achievable. Realistic. Time sensitive. Remember why you are exercising and what it was you wanted to achieve in the first place. It might be running 5km in under a specified time, doing 5 chin-ups, or holding a plank for 2mins.
Exercise with a friend. Having a partner in exercise can increase accountability. No one likes to let a friend down, and sharing is caring, particularly when DOMS might raise it's head.
Plan your exercise times. Block out time in your schedule to exercise. If you miss a session, don’t sweat it. Just look to the next session and commit to it.
Exercise early. While it can be hard getting up early to exercise, most of us will feel better for it and have more energy for the day ahead. It also reduces the chances of missing a session as things always seem to come up at the end of the day.
Keep it interesting. Vary your sessions throughout the week. Mix in some longer runs or a bike ride, lift some weights, do a stretch session, or challenge your core muscles.
Eat and drink mindfully. A well-balanced diet will keep you feeling healthier and give you more energy, not just for exercise but for everything life throws your way. Hydrate well – drink plenty of water and try to avoid sugary drinks, including energy drinks that are calorie laden.

Enjoy a beer or a G&T if that’s your thing, just do it in moderation and try not to overindulge the night before. Exercise with a hangover is not much fun.

The Take Home

The off-season is a key period for any athlete no matter your level of expertise. Planned and managed carefully it will ensure the gains from the year just gone compound into the next season and are not just lost to the couch. Keep in mind that the purpose of this phase is to pull back and let the body physically and mentally freshen up, manage injuries and niggles, and reconnect with other aspects of life.

Do you want to improve your on-field performance and reduce your injury risk? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Clemente, F. M., Ramirez-Campillo, R., & Sarmento, H. (2021). Detrimental effects of the off-season in soccer players: a systematic review and meta-analysis. Sports Medicine, 51, 795-814.
Herridge, R., Turner, A., & Bishop, C. (2020). Monitoring changes in power, speed, agility, and endurance in elite cricketers during the off-season period. The Journal of Strength & Conditioning Research, 34(8), 2285-2293.
Loturco, I., Nunes, R. F., Lampert, R. R., Silva, R. L., Hespanhol, J. E., Novack, L. F., ... & McGuigan, M. R. (2024). Effects of two different low-volume resistance training programs applied during the off-season period on the speed-power performance of elite youth soccer players. The Journal of Strength & Conditioning Research, 38(3), 571-576.
Mujika, I., Halson, S., Burke, L. M., Balagué, G., & Farrow, D. (2018). An integrated, multifactorial approach to periodization for optimal performance in individual and team sports. International journal of sports physiology and performance, 13(5), 538-561.
Twist, C., Williams, J., & Dobbin, N. (2022). Deteriorations in physical qualities during a 10-week unsupervised off-season period in academy rugby union players. Science and Medicine in Football, 6(3), 347-354.

The Hip - Gluteal Tendinopathy

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 28 Nov 2024 05:39:31 GMT

Lateral hip pain is common in females and a significant cause of reduced physical activity.

Gluteal tendinopathy, a common cause of lateral (outside) hip pain, occurs when the tendons that attach the gluteal muscles to the hip bone become irritated due to excessive or imbalanced loading. This condition is frequently observed in middle-aged women and individuals involved in repetitive activities like running or walking. Luckily, with a well-structured rehabilitation program your physiotherapist can help you recover.

Anatomy 101

Muscles attach to bone via tendons, a strong, relatively non-elastic material that is excellent at transferring the contraction force of a muscle into movement (or stability) across a joint. Under normal conditions, healthy tendon tissue responds to the cycle of overload and adequate rest by increasing its load capacity.

In the gluteal region there are three primary muscles — gluteus maximus, gluteus medius, and gluteus minimus. The gluteus medius and gluteus minimus muscles play a critical role in hip and pelvis stability. They originate from the outer surface of the pelvis, and their tendons attach to the greater trochanter, the bony prominence on the side of the hip. When standing on one leg, these muscles ensure that your hip doesn’t drop down on the other side.

Who gets it?

A relatively common condition, gluteal tendinopathy is estimated to affect between 10-25% of the population. Women aged 40-60 years of age are more frequently affected, with high levels of pain and dysfunction affecting physical activity and quality of life.

In individuals with variations in pelvic or femoral anatomy, such as a wide pelvis or increased femoral anteversion, the tendons may be subjected to higher mechanical loads, increasing the risk of tendinopathy.

Causes of Gluteal Tendinopathy

Tendinopathy is referred to as an overuse injury, as the tendon has undergone pathological changes due to exposure to excessive load over time. When localised tendon cells are exposed to repeated tensile (stretching) and compressive forces beyond their capacity with inadequate recovery time, they start to break down, with gradual development of pain and dysfunction.

Tendinopathy can occur in any tendon, commonly the heel, knee, shoulder, elbow and hip. In the gluteal region, causes include:

Repetitive overloading: High levels of repetitive activity, such as running, prolonged standing, or walking long distances, can strain the tendons.
Compressive forces: Positions that press the tendon against the bone, such as lying on one side or crossing the legs, can exacerbate symptoms.
Muscle weakness or poor activation: Insufficient strength or control of the gluteal muscles places additional stress on the tendons.
Suboptimal biomechanics: Some movement patterns, such as excessive hip adduction during walking or running ( Trendelenburg gait ), can lead to overloading of the tendons.
Systemic or metabolic factors: having diabetes or cardiovascular health problems, or being overweight can increase systemic inflammation and raise the risk profile for tendinopathy.

Symptoms of Gluteal Tendinopathy

Slow onset pain over the outside of the hip that gradually worsens over time is the main feature of gluteal tendinopathy. Patients will often report:

Pain or tenderness on the outer hip, especially when standing on one leg, climbing stairs, or walking.
Difficulty sleeping on the affected side due to pain.
Increased discomfort after prolonged periods of activity or sitting with legs crossed.
Tip: If you get pain when you manipulate socks and shoes (either on or off) then it is more likely that you have hip osteoarthritis than gluteal tendinopathy.

Diagnosing Gluteal Tendinopathy

Diagnosis is primarily clinical, with specific tests designed to provoke symptoms and assess functional limitations. Your physiotherapist will palpate the painful area and assess your movement and strength. There are some specific tests that are helpful including standing on one leg and putting your hip in certain positions. It is important to rule out problems like hip joint arthritis or low back problems which can refer pain to the outer hip.

Imaging, such as ultrasound or MRI, may be used in persistent cases to confirm the diagnosis or rule out other conditions, but it is not usually necessary.

Management and Treatment

Effective management of gluteal tendinopathy requires a wholistic approach addressing pain, range of motion, strength and load.

Load Management. Reducing provocative activities is essential to allow the tendon to recover. Your physio will help you modify activities like stair climbing, prolonged standing, or sitting in positions that compress the tendon. Importantly, complete rest is not advised, as tendons require a certain level of load to maintain their health.
Exercise Therapy. A progressive exercise program tailored to the individual is the cornerstone of treatment. Exercises must be tailored to the individual, incorporating isometric (static), concentric (shortening under load) and eccentric (lengthening under load). Graduated load exposure is essential to build the capacity of the tendon under a variety of conditions, with progression towards meaningful functional activities.
Optimizing Movement Patterns. Correcting biomechanical issues can be helpful. Strategies may include changes to your gait (walking and running) such as widening your step width, increasing your cadence, or strengthening calf muscle power.

Incorporating functional movement patterns like single-leg step-ups, squats, lunges and lifting tasks helps prepare the tendons for daily demands.

What about an injection?

Corticosteroid injections (CSI) are not recommended as a first line treatment for gluteal tendinopathy. While studies indicate they can provide short term pain relief, they are less effective than a good quality exercise and education program in terms of both pain and function. Corticosteroids are harmful to tendon cells and reduce their capacity to heal, which may delay healing and prolong recovery. They should only be considered in recalcitrant cases and only when combined with a high-quality therapeutic exercise program that accounts for the detrimental effects on tendon cell health.

Recovery Timeframe

Recovery varies based on the severity of the condition and adherence to the rehabilitation program. Tendons adapt slowly, so a consistent, graded approach over several months is often required. Early intervention typically results in better outcomes.

The Take Home

While Gluteal Tendinopathy can be challenging, many people successfully manage it with the right combination of treatment, load management, and lifestyle adjustments. GT requires a tailored program designed around the specific goals of the patient. Early assessment and diagnosis, careful planning around activity modification and therapeutic exercise, full recovery from GT is achievable.

Got lateral hip pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your hip pain and let you know whether you have gluteal tendinopathy, hip joint osteoarthritis, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Allison, K., Hall, M., Hodges, et al. (2018). Gluteal tendinopathy and hip osteoarthritis: different pathologies, different hip biomechanics. Gait & Posture, 61, pp.459-465.
Cook, J. L., & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409–416.
Fearon, A.M., Scarvell, J.M., Neeman, et al. (2013). Greater trochanteric pain syndrome: defining the clinical syndrome. British journal of sports medicine, 47(10), pp.649-653.
Ganderton, C., et al. (2018). Gluteal tendinopathy: Clinical diagnosis, management, and pathophysiology. Journal of Orthopaedic & Sports Physical Therapy, 48(4), 239–249.
Grimaldi, A., & Fearon, A. (2015). Hip-related pain in adults—Clinical assessment and management. British Journal of Sports Medicine, 49(22), 1397–1404.
Grimaldi, A. (2023). Injections for hip pain: Options, benefits, and risks. Dr. Alison Grimaldi. https://dralisongrimaldi.com/blog/injections-for-hip-pain-options-benefits-risks/
Millar, N. L., Silbernagel, K. G., Thorborg, K., Kirwan, P. D., Galatz, L. M., Abrams, G. D., Murrell, G. A. C., McInnes, I. B., & Rodeo, S. A. (2021). Tendinopathy. Nature reviews. Disease primers, 7(1), 1. https://doi.org/10.1038/s41572-020-00234-1
Rio, E., et al. (2015). Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. British Journal of Sports Medicine, 49(19), 1277–1283.
Wilson, R., Abbott, J.H., Mellor, R., et al. (2023). Education plus exercise for persistent gluteal tendinopathy improves quality of life and is cost-effective compared with corticosteroid injection and wait and see: economic evaluation of a randomised trial. Journal of Physiotherapy, 69(1), pp.35-41.

The Shoulder - Multi-Directional Instability

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 15 Nov 2024 00:50:15 GMT

The shoulder sacrifices stability for mobility, increasing injury risk in high repetition activities.

Multi-directional instability (MDI) of the shoulder is a condition which commonly affects young athletes and individuals with naturally looser joints. MDI can cause pain and hinder daily activities, but with proper treatment and rehabilitation, many people can manage their symptoms effectively. In this blog, we’ll explore the causes, symptoms, treatment options, and prevention strategies for MDI of the shoulder.

Anatomy of the Shoulder

The shoulder joint is highly mobile, which is great for activities like throwing, lifting, reaching and swimming. However, this flexibility also increases its vulnerability to instability. The shoulder joint, or glenohumeral joint, consists of the humeral head (ball) and the glenoid (socket) of the shoulder blade. A network of muscles, ligaments, and the labrum (a fibrocartilage ring surrounding the glenoid) provides support and stability. When these supporting structures are too lax or weakened, the humeral head can move excessively, leading to MDI.

What is Multi-Directional Instability?

MDI is a form of shoulder instability where the shoulder becomes unstable in multiple directions: typically forward (anterior), backward (posterior), and downward (inferior).

Unlike traumatic dislocations, which often result from a specific injury, MDI develops gradually due to genetic ligament laxity, muscle imbalances, or repetitive overhead movements causing micro-trauma.

MDI can be especially common in athletes and those with hypermobility disorders, as their shoulder structures are naturally more flexible. It seems to effect people mostly in their 20s and 30s and becomes less common after 40.

Causes of Multi-Directional Instability

Genetic Ligamentous Laxity : Some people are born with looser ligaments, which increases the risk of instability. This trait, often hereditary, can affect other joints as well.
Repetitive Overhead Movements : Any sporting pursuit that involves repetitive arm movement can cause micro-traumatic stress culminating in joint laxity. Sports like swimming, tennis, gymnastics, athletics (discuss, shot put, javelin), throwing sports (baseball, cricket) and water polo to name a few.
Muscle Imbalance : Weakness or imbalances in the shoulder and scapular muscles can contribute to the development of MDI by failing to provide adequate stability during movement.

Symptoms of Multi-Directional Instability

Common symptoms of MDI include:

Pain and Discomfort : Pain may occur with movement, especially with activities involving arm elevation.
Sensation of "Slipping" or "Subluxation" : Many individuals report a feeling of the shoulder slipping partially out of place, often causing them to avoid certain movements.
Weakness and Fatigue : Shoulder muscles may become easily fatigued, limiting endurance and strength.
Limited Range of Motion : Movement restrictions may develop over time due to discomfort or compensatory muscle stiffness.

Diagnosing Multi-Directional Instability

MDI can be diagnosed by a physiotherapist in the clinical setting. Diagnosing MDI involves taking a thorough history and completing a physical examination, including specific tests to evaluate ligamentous laxity, such as the sulcus sign or load and shift tests. Your physio will ask you to perform movements which cause you to experience symptoms to assess for signs of instability. They will also assess your range of movement and muscle strength.

MDI presents similarly to other shoulder conditions, such as shoulder subluxation , impingement , and rotator cuff tendinopathy , so make sure you get a clear diagnosis early.

Do I need a scan?

Most people don’t require imaging. Sometimes during the clinical exam symptoms are identified that may warrant further investigation to assist with management and planning. MRI, X-ray, or ultrasound can be helpful, and your physiotherapist will discuss if this is appropriate for you.

Treatment for Multi-Directional Instability

In the absence of other conditions (such as a labral injury or rotator cuff tear), MDI can be managed effectively with a conservative (non-surgical) approach. This usually involves:

Education: The first step in managing MDI is understanding what has caused your symptoms, how you can improve them, and time frames involved.
Physiotherapy : Strengthening the muscles that stabilize the shoulder is key to managing MDI. Control of the scapular (shoulder blade) plays a crucial role in shoulder stability, as does the strength and timing of activity in the rotator cuff muscle group. A physiotherapist will guide you through exercises that are specific to your presentation and target the rotator cuff, deltoid, and scapular muscles to enhance shoulder stability. Check out a general exercise program here .
Activity Modification : Limiting activities that place high stress on the shoulder, like repetitive overhead motions, can reduce symptoms. Your physio will work with you to modify your activities so that you can still do the things you love with less difficulty.
Bracing and Taping : In some cases, a brace or supportive taping may help stabilize the shoulder during activities, especially for athletes or individuals engaging in high-demand physical activities.

Will I need surgery?

For some people surgery may be considered after 9-12 months of failed conservative management or for those people with co-morbidities. Procedures such as capsular tightening or labral repair can restore stability to the joint. Minimally invasive arthroscopic surgery is often preferred due to a shorter recovery time.

Preventing Multi-Directional Instability

If you have a genetic predisposition or engage in sports that place you at risk of shoulder joint MDI, there are preventative strategies you can use to lower your risk and maintain shoulder health.

Strength Training : Regularly strengthening the rotator cuff and scapular muscles can improve stability and reduce the risk of MDI.
Postural Awareness : Maintaining good posture helps distribute shoulder forces evenly, reducing stress on the joint.
Warm-Up and Stretching : Warm-up exercises before engaging in sports or workouts prepare the shoulder for movement and help prevent strain.
Avoid Overuse : Athletes or active individuals should be mindful of repetitive stress and incorporate rest days to allow the shoulder to recover.

The Take Home

While MDI can be challenging, many people successfully manage it with the right combination of treatment, load management, and lifestyle adjustments. MDI can be confused with other conditions which require different management approaches, so if you have shoulder pain get it assessed properly by a qualified health professional. Early intervention, strength training, and activity modification can make a significant difference, helping you regain function and prevent future complications.

Got shoulder pain and/or instability and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shoulder pain and let you know whether you have multi-directional instability, a labral injury, a rotator cuff tear, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

DeFoor, M.T. and Sheean, A.J. (2024). Shoulder Multidirectional Instability. In Orthopaedic Sports Medicine: An Encyclopedic Review of Diagnosis, Prevention, and Management (pp. 1-16). Cham: Springer International Publishing.
Hippensteel, K. J., Uppstrom, T. J., Rodeo, S. A., et al. (2023). Comprehensive Review of Multidirectional Instability of the Shoulder.  The Journal of the American Academy of Orthopaedic Surgeons ,  31 (16), 871–880. https://doi.org/10.5435/JAAOS-D-22-00983
Johnson, D. J., & Tadi, P. (2023). Multidirectional Shoulder Instability. In  StatPearls . StatPearls Publishing.
Longo, U.G., Rizzello, G., Loppini, M., et al. (2015). Multidirectional instability of the shoulder: a systematic review. Arthroscopy: The Journal of Arthroscopic & Related Surgery , 31 (12), pp.2431-2443.
Spanhove, V., Van Daele, M., Van den Abeele, et al. (2021). Muscle activity and scapular kinematics in individuals with multidirectional shoulder instability: a systematic review. Annals of Physical and Rehabilitation Medicine , 64 (1), p.101457.
Stokes, D. J., McCarthy, T. P., and Frank, R. M. (2023). Physical Therapy for the Treatment of Shoulder Instability.  Physical medicine and rehabilitation clinics of North America ,  34 (2), 393–408. https://doi.org/10.1016/j.pmr.2022.12.006
Warby, S. A., Watson, L., Ford, J. J., et al. (2017). Multidirectional instability of the glenohumeral joint: Etiology, classification, assessment, and management.  Journal of hand therapy : official journal of the American Society of Hand Therapists ,  30 (2), 175–181. https://doi.org/10.1016/j.jht.2017.03.005
Watson, L., Warby, S., Balster, et al. (2016). The treatment of multidirectional instability of the shoulder with a rehabilitation program: Part 1.  Shoulder & elbow ,  8 (4), 271–278. https://doi.org/10.1177/1758573216652086
Watson, L., Warby, S., Balster, S., et al. (2017). The treatment of multidirectional instability of the shoulder with a rehabilitation programme: Part 2.  Shoulder & elbow ,  9 (1), 46–53. https://doi.org/10.1177/1758573216652087

The Shoulder - Glenohumeral Joint Dislocation

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 14 Nov 2024 02:42:41 GMT

Shoulder dislocation is a significant injury requiring urgent assessment by a medical professional.

The shoulder one of the most commonly dislocated joints in the body, largely occurring during sporting pursuits or as a result of a fall or accident. While the shoulder joint is designed for a wide range of motion, this makes it more vulnerable to dislocations. A dislocated shoulder can painful and debilitating but with the right treatment and rehabilitation, most people can return to their normal activities with full function.

In this blog, we’ll discuss the causes, symptoms, treatment options, and rehabilitation process for shoulder dislocations, as well as what you can do to prevent them.

Anatomy 101.

The shoulder has a lot of natural mobility, which is great for many of the daily activities and sport we like to participate in. Hanging washing, throwing a ball, swimming, playing tennis, scratching our backs, even dressing, are all reliant on the large range of motion in a normal functioning shoulder joint. However, this vast degree of mobility comes at a cost to stability. The shoulder joint has a relatively large head compared with the socket. It therefore relies heavily on ligament and muscle support, and an intact labrum - a fibrocartilage ring that surrounds the socket, deepening this part of the shoulder joint and increasing the contact surface area with the humeral head.

When the shoulder is dislocated , many of these structures can be stretched and damaged, impacting the dynamic support of the shoulder and affecting normal shoulder function.

Who get’s it?

Studies from the UK and the US have shown that more than 70% of shoulder dislocations occur in men, with a peak incidence occurring between the ages of 16 and 20 years. For women, the peak incidence is much later in life, between 61 and 70 years of age.

Approximately 75% of first-time shoulder dislocations are sustained during some form of sporting activity.

Shoulder joint dislocation is more common in sporting populations, particularly basketball, football (American and Australian Rules), soccer, baseball and weightlifting. Later in life, osteoarthritis, deconditioning and falls contribute to the incidence of shoulder dislocation.

What is a shoulder dislocation?

Shoulder dislocation is part of the spectrum of injury called shoulder instability.

A shoulder dislocation occurs when the ball of the upper arm bone (humerus) comes out of the shallow socket of the shoulder blade (glenoid). This can happen in two ways:

Anterior Dislocation: The most common type, where the head of the humerus is forced forward, usually due to a fall or direct impact. 90% of shoulder dislocations are anterior.
Posterior Dislocation: Less common but often occurs during seizures or electrical shocks, where the humerus moves backward.

Shoulder dislocations can also be partial (called subluxations), where the humerus shifts out of place but doesn’t completely come out of the socket. You can read more about shoulder subluxation here .

What causes a shoulder dislocation?

Shoulder dislocations can occur in various ways, but common causes include:

Sports Injuries: Contact sports such as football, rugby, or hockey are common causes, especially in tackles or collisions.
Falls: Falling onto an outstretched arm or directly onto the shoulder can lead to a dislocation.
Trauma or Accidents: A car accident or a direct blow to the shoulder can force the joint out of its normal position.
Weak or Imbalanced Muscles: Muscular weakness or poor stability in the shoulder can increase the risk of dislocation, especially in people who have a hypermobility syndrome.

What are the symptoms of a shoulder dislocation?

If you have experienced a shoulder dislocation, you’ll likely notice the following symptoms:

Severe pain in the shoulder, especially when trying to move it.
Deformity. The shoulder may appear "out of place," or the contour of the shoulder may look abnormal.
Inability to move the arm. It will be very painful or difficult to move the shoulder joint.
Swelling and bruising around the joint.
Numbness or tingling. This can occur if nerves around the shoulder are compressed or stretched.

How is a shoulder dislocation treated?

If you suspect a shoulder dislocation, it’s crucial to seek immediate medical attention.

A healthcare professional will assess the injury and perform a physical exam and X-rays to confirm the dislocation and rule out other injuries, such as fractures. The treatment typically involves:

Reduction: The first step is to carefully reposition the humeral head back into the socket. This is typically done under local anaesthesia or sedation to minimize pain.
Immobilization: After the dislocation is reduced, the shoulder is usually placed in a sling or immobilizer to allow the ligaments and tissues to heal.
Pain Management: Anti-inflammatory medications and ice packs can help reduce pain and swelling.
Rehabilitation: After the initial healing phase, physical therapy is essential to restore strength, range of motion, and stability to the shoulder.

Some people experience chronic or frequent dislocations. If this happens to you it is important you have an individualised plan developed for how to manage when this occurs.

Do I need a scan?

First time dislocations, particularly traumatic dislocations in persons aged over 40, will be routinely investigated using x-ray prior to relocation to screen for associated fractures which might impact treatment and management. Additionally, in younger populations and those returning to contact or high-risk sport, MRI may be required to assess injury to ligaments, capsular tissue and the labrum. You can learn more about labral injuries here .

For recurrent dislocations, imaging is not necessarily required. Signs and symptoms should be monitored and investigations ordered if indicated.

Rehabilitation After a Shoulder Dislocation

Once the shoulder is back in place, rehabilitation is key to ensure a full recovery and reduce the risk of re-injury. The rehabilitation process typically progresses through the following stages:

Stage 1: Pain Management and Rest: During the first few days after the dislocation, the focus will be on pain relief and reducing inflammation. Gentle movements may be encouraged as the joint heals.
Stage 2: Restoring Range of Motion: Once the pain subsides, exercises that focus on regaining mobility will be introduced. These will be gentle and designed to avoid overstretching the ligaments.
Stage 3: Strengthening: Strengthening exercises for the rotator cuff and surrounding muscles are crucial to stabilize the shoulder and prevent future dislocations. These exercises will gradually increase in intensity.
Stage 4: Functional Rehabilitation: This stage involves sport-specific or activity-specific exercises to prepare you for return to normal activities or sports. The goal is to achieve normal pain-free range of motion and strength comparative with the unaffected side.

Tip: It’s essential to follow your physiotherapist’s instructions carefully during rehabilitation to avoid putting too much strain on the joint before it is fully healed.

The Take Home

Shoulder dislocations are relatively common, particularly in sport environments. They can be serious injuries. First time dislocations need prompt medical input and appropriate investigations to ensure a good outcome is achieved. Relocation should only be attempted by an experienced, qualified health professional. Specially designed rehabilitation programs will accelerate return to sport duration, with a decision to return to sport based on symmetry of movement and strength. With prompt treatment and individualised rehabilitation, most people recover fully and return to their activities.

Got shoulder pain and want to get it sorted? Give us a call now.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Braun, C. and McRobert, C.J. (2019). Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Cochrane Database of Systematic Reviews, (5).
Chiddarwar, V., de Zoete, R.M., Dickson, C. and Lathlean, T. (2023). Effectiveness of combined surgical and exercise-based interventions following primary traumatic anterior shoulder dislocation: a systematic review and meta-analysis. British Journal of Sports Medicine, 57(23), pp.1498-1508.
Griffin, J., Jaggi, A., Daniell, H. and Chester, R. (2023). A systematic review to compare physiotherapy treatment programmes for atraumatic shoulder instability. Shoulder & Elbow, 15(4), pp.448-460.
Hasebroock, A.W., Brinkman, J., Foster, L. and Bowens, J.P. (2019). Management of primary anterior shoulder dislocations: a narrative review. Sports medicine-open, 5, pp.1-8.
Kavaja, L., Lähdeoja, T., Malmivaara, A. and Paavola, M. (2018). Treatment after traumatic shoulder dislocation: a systematic review with a network meta-analysis. British journal of sports medicine, 52(23), pp.1498-1506.
Olds, M., and Sole, G. (2024). Acute rehabilitation after traumatic shoulder dislocation. British Medical Journal, 384.
Shah, R., Chhaniyara, P., Wallace, W.A. and Hodgson, L., 2017. Pitch-side management of acute shoulder dislocations: a conceptual review. BMJ Open Sport & Exercise Medicine, 2(1), p.e000116.
Twomey-Kozak, J., Whitlock, K. G., O’Donnell, J. A., et al. (2021). Shoulder dislocations among high school–aged and college-aged athletes in the United States: an epidemiologic analysis. JSES international, 5(6), 967-971.
Verweij, L. P., Baden, D. N., van der Zande, J. M., et al. (2020). Assessment and management of shoulder dislocation. British Medical Journal, 371.

Sciatica

Mon, 11 Nov 2024 05:20:43 GMT

Education and exercise is the best course of action for sciatica.

Sciatica is a broad term used to describe pain that is neural in origin and refers or radiates into the leg. Often used to describe any type of back or leg pain, it should be reserved for pain that originates from the lower back and refers pain downwards from the buttocks along the course of the lumbosacral nerves. In most cases, sciatica is transient, and responds well to conservative treatment, with 90% of people improving within 4 months of symptom onset.

Fun fact: Hippocrates is said to be the first physician to use the term “sciatica”, describing ischiatic (hip) pain in men aged between 40 and 60 years. It wasn’t until the early 20 ^th century though that compression of the nerve root by the intervertebral disc was considered a possible cause of sciatica.

Anatomy 101

The sciatic nerve is the thickest nerve in the body, measuring approximately 2cm wide. It is formed from the nerve roots of L4, L5, S1, S2 and S3 which merge in the pelvis and then descend through the buttocks and down the back of the thigh. Just above the knee joint, the nerve divides into the tibial nerve and the common peroneal nerve which continues down the lower part of the leg. You can get a detailed description of sciatic nerve anatomy here .

The sciatic nerve provides motor supply to the hamstring muscles and parts of the groin muscle adductor magnus, as well as some muscles in the lower leg. It also provides sensory supply to the leg and foot. Compression or irritation of the sciatic nerve, particularly at the level of the nerve roots, can result in pain that radiates into the leg in specific patterns known as dermatomes , and, in some instances, result in weakness of the leg and foot.

Who gets it?

Sciatica is a common condition with a lifetime prevalence of up to 43%, though this does vary widely due to the low-quality research on sciatica to date and the variation in how sciatica is defined. Sciatica affects men and women equally and is most common in people aged 30-50. Factors including age, height, stress, smoking and exposure to vibration and manual handling can all increase the risk of developing sciatica. Most people who experience sciatica will have a history of low back pain.

In approximately 85- 90% of cases of sciatica, a herniated intervertebral disc causes lumbar nerve root compression or inflammation resulting in referred pain (sciatica) down the leg.

Diagnosing Sciatica

Sciatica can be diagnosed based on the patient’s symptoms and the findings on physical examination. Sciatica commonly develops gradually. It is often preceded by back pain, though at the time of presenting to a health professional leg pain is generally the dominant symptom. Leg pain will often follow a dermatomal distribution indicating which nerve root is compromised. Coughing, sneezing, or deep breathing may exacerbate pain.

Physically sciatica results in a reduction in straight leg raise range. Numbness and/or altered sensation may follow a dermatomal pattern, and in some instances leg strength and/or reflexes may be altered.

Sciatica is usually caused by compression of one or more nerve roots by a bulge in the intervertebral disc. However other underlying pathology such as trauma, cancer or serious infections may also cause sciatica. The presence of saddle paraesthesia, altered bowel and bladder function, and reduced sexual function could indicate cauda equina syndrome requiring immediate medical attention.

Do I need a scan?

Medical imaging (X-ray, MRI, CT scan) is not normally indicated for patients presenting with sciatica unless the clinical picture suggests an atypical presentation and more serious pathology is being considered as a cause.

International guidelines do not recommend routine imaging for patients with sciatica.

Reliance on imaging for a clinical diagnosis can have unintended consequences. As with non-specific low back pain, people presenting with sciatica can have a range of changes on imaging, including normal age-related degenerative changes. These signs may be unrelated to the presenting symptoms. Nevertheless, they can distract from best-practice treatment and exacerbate patient stress and anxiety, prolonging symptom resolution and potentially the pursuance of ineffective and unnecessary interventions.

Treatment

Treatment guidelines for sciatica follow a stepwise model starting with therapeutic exercise and education, progressing to pharmacological and targeted treatment (such as ultrasound guided corticosteroid injection) if the pain is intractable.

Surgery should only be considered when conservative treatments have not been effective and radiological findings are consistent with symptoms.

Early referral to physiotherapy is important. Initial treatment for sciatica involves education and exercise, with a strong emphasis on staying active. This is an important element of conservative management, particularly for people who have had symptoms for less than 6-8 weeks. Exercise should be aligned with the patient’s symptoms and the goals and experience of the patient. You can access a general exercise program for sciatica here .

Bed rest for sciatica is NOT recommended.

Pain medication has not been shown to have a significant effect on sciatic pain. Coritcosteroids can improve pain in the short term, however they can have considerable side effects. The Dutch GP guideline therefore recommends a cautious approach to the use of pain medication for sciatica for patients with severe pain only.

If symptoms persist following a period of conservative treatment, then the stepwise model for sciatica management recommends referral to a spinal surgeon to evaluate if there is an indication for lumbar surgery. The most common procedure undertaken for severe sciatic pain is lumbar discectomy surgery, where the portion of the lumbar disc that is compressing the nerve root is removed. Some patients will identify rapid relief of leg pain as an important treatment goal. For these patients, discectomy could be an early management option where the benefits outweigh the risks and costs.

How long’s it going to take?

In a recent study (2020), Konstantinou et al found a median time to recovery of 10-12 weeks, with most people making a full recovery in a couple of months. Only a small percentage (<3%) required spinal surgery.

While surgery can provide rapid relief of leg pain, it carries with it an increased risk of an adverse event, such as infection or increased back pain. Studies have shown that non-surgical treatment can achieve similar outcomes albeit at a slower pace and with the potential need for delayed surgery if conservative treatment fails.

The Take Home

Sciatica is a painful, usually transient condition caused by compression of one or more nerve roots in the lower back resulting in referred pain to the leg. Stepwise treatment is recommended, commencing with physiotherapy as early as possible, with options to progress to more invasive treatment where symptoms persist. For the majority of clinical presentations, education, therapeutic exercise and advice to stay active will see an improvement within 4 months from symptom onset and a gradual return to pre-injury activities.

Got sciatica and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your deep gluteal or leg pain and let you know whether you have sciatica or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources.

Bailey, C. S., Rasoulinejad, P., Taylor, D., et al. (2020). Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. New England Journal of Medicine, 382(12), 1093-1102.
Dove, L., Jones, G., Kelsey, L. A., et al. (2023). How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. European Spine Journal, 32(2), 517-533.
Konstantinou, K., Lewis, M., Dunn, K. M., et al. (2020). Stratified care versus usual care for management of patients presenting with sciatica in primary care (SCOPiC): a randomised controlled trial. The Lancet Rheumatology, 2(7), e401-e411.
Liu, C., Ferreira, G. E., Shaheed, C. A., et al. (2023). Surgical versus non-surgical treatment for sciatica: systematic review and meta-analysis of randomised controlled trials. British Medical Journal, 381.
Ostelo, R. W. (2020). Physiotherapy management of sciatica. Journal of physiotherapy, 66(2), 83-88.
Ryan, C., Pope, C. J., & Roberts, L. (2020). Why managing sciatica is difficult: patients’ experiences of an NHS sciatica pathway. A qualitative, interpretative study. BMJ open, 10(6), e037157.

The Knee - Osteoarthritis

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 04 Oct 2024 00:52:22 GMT

Before a needle or the knife, try some exercise. It's best practice.

Knee osteoarthritis, or knee OA, is one of the most prevalent and debilitating chronic degenerative joint diseases, affecting up to 30% of people aged over 50, with a hallmark symptom of pain. This in turn can affect balance, with a concomitant increase in the risk of falls and associated injuries.

In Australia we have comprehensive guidelines based on research helping us to know how to assess and manage this condition. These guidelines support a non-surgical approach as first-line management for knee OA, with strong evidence for exercise coupled with appropriate pain relief and targeted physiotherapy. Check out this fact sheet for more information about knee OA.

A little bit of anatomy

The knee is made up of two main joints – the tibiofemoral joint between the shin bone (tibia) and the thigh bone (femur), and the patellofemoral joint between the kneecap (patella) and the femur. The ends of the bone are covered with articular cartilage which absorbs and distributes load and helps with smooth movement. There is another thicker cartilage between the thigh bone and shin bone called the meniscus which adds another layer of shock absorption and improves contact between the tibia and femur.

Osteoarthritis affects all the structures of the knee joint including the ligaments, nerves, and muscles, but mainly the articular cartilage.

Normally, there is a balance between the body making new cartilage to replace older cartilage. In osteoarthritis this balance is impacted which can affect the amount of healthy cartilage. Pain associated with knee OA arises from changes to surrounding tissues, particularly the synovial tissue, as well as articular cartilage. As tissues become tight and stiff, the biomechanics of the joint are altered, impacting the way load is distributed. Alterations to the thickness of articular cartilage further affect load absorption and distribution, resulting in further degenerative change.

Who gets it?

Knee osteoarthritis is common in Australia, affecting 1.2 million people, with females impacted at slightly higher rates than males. About 70% of people with knee osteoarthritis are older than 55, however younger people can also be affected. Factors that contribute to an increased risk of developing osteoarthritis include a history of knee injuries, previous surgery, and being overweight. There may also be a link with overall health including blood pressure, diabetes and high cholesterol.

Obesity remains one of the most important risk factors for the incidence and progression of OA.

Obesity increases the risk of OA in both weight-bearing (knee) and non-weight-bearing (hand) joints and doubles the lifetime risk of symptomatic OA compared to individuals with a lower BMI. Recent studies have demonstrated that factors related to obesity – adipose deposition, insulin resistance, and altered immune responses – may lead to the initiation and progression of obesity-associated OA.

Diagnosing Knee OA

Symptoms common to knee OA include intermittent or constant knee pain that is gradual in onset and worsens with activity, joint stiffness, particularly first thing in the morning, crepitus or cracking with certain activities such as ascending stairs or squatting, and pain after prolonged sitting or resting. The most common symptom of pain arises due to changes in the synovial tissue, and redistribution of load away from the cartilage (which has minimal nerve supply and loves load) to the underlying bone which has a rich nerve supply and is not tolerate of these forces.

Signs of knee OA include joint swelling and redness, reduced knee joint range of motion, reduced balance, and joint line tenderness.

As there are many causes of knee pain it is important to see a qualified health professional to get a clear diagnosis. Your physiotherapist will listen carefully to you describe your symptoms and complete a thorough physical examination. A diagnosis of knee osteoarthritis is made if you have knee pain which is worse with activity, show signs and symptoms consistent with knee OA, and other causes of symptoms are ruled out.

Do I need a scan?

Scans are not recommended for diagnosing osteoarthritis. One of the reasons for this is what is seen on a scan does not normally match very well with a person’s symptoms, and generally will not change the recommended management.

In one study only 15% of patients with radiographic findings of OA had symptoms of OA.

A scan is only required if you have an atypical presentation, or if surgery might be indicated, which is a small percentage of people. Some people may require blood tests to rule out other conditions like rheumatoid arthritis.

Treatment

Exercise is the number one treatment for osteoarthritis and is recommended in all international guidelines.

Exercise should be the first line of treatment for all patients. This could include specific strengthening exercises, a walking program, or hydrotherapy. Often when getting started with exercise pain can initially flare up, so working with a skilled physiotherapist is important to get the right balance.

Weight loss can be helpful if you are overweight. Research shows that losing even 2kg can significantly reduce levels of pain. Weight loss can be difficult and there are multiple factors involved in a person’s weight. Your physiotherapist can support you in planning if this is a priority for you.

Soft tissue therapy, manual therapy, pain medication, and/or joint injections are all options that can be tried if exercise is not having a large enough effect. These modalities can provide short term pain relief and improvements in function which can improve participation in therapeutic exercise. However, they are not a panacea, nor a replacement for exercise, and should not be pursued in isolation or for long periods of time.

Can I get an injection?

There are several injectable options available to persons with knee OA who have not progressed sufficiently with therapeutic exercise. It is important to recognize that injections are an invasive technique, and as such carry an increased risk profile for complications including infection. You can click on the links below for more information:

Will I need surgery?

Most people with knee joint OA will not require surgery. A small percentage of people will require joint replacement surgery. This is considered if the problem is not responding to other noninvasive treatments and is having a significant impact on quality of life. Arthroscopic surgery to “clean up” a knee joint with osteoarthritis has been shown to have no benefit.

Prior to considering surgery it is important that you have completed at least 3 months of a good quality exercise program. This is the minimum timeframe necessary to ascertain the benefits of a non-surgical approach and to improve strength and knee joint biomechanics. Failing this, your physiotherapist can provide guidance on available medical and surgical treatments, enabling you to make informed health care decisions.

How long’s it going to take?

Currently there is no cure for osteoarthritis. OA needs to be managed over time with regular adjustments to lifestyle, daily living activities, and exercise type and quantity. Prognosis is positive for most people, and with a simple, progressive, therapeutic exercise program combined with lifestyle changes they can continue with good function.

Pain flare ups can occur and can be effectively managed with over the counter pain medication, soft tissue therapy, and adjustments to exercise programs. Research shows that people who continue with exercise programs over a long period tend to have less flare ups, improved functional capacity and better health-related quality of life.

Take home Advice

Knee osteoarthritis is a common condition causing knee joint pain and stiffness. Your physiotherapist can make a diagnosis without any scans or blood tests. Guidelines recommend that the first line treatment for all people is exercise, and that this is highly effective in reducing pain and improving function under the guidance of a physiotherapist.

Got knee pain and want to get it sorted? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References:

Australian Commission on Safety and Quality in Healthcare. (2024). Osteoarthritis of the Knee Clinical Care Standard. Retrieved October from https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard
Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., et al. (2019, Nov). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 27(11), 1578-1589. https://doi.org/10.1016/j.joca.2019.06.011
Deyle GD, Allen CS, Allison SC, et al. Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 2020;382(15):1420-1429. doi:10.1056/NEJMoa1905877
Henriksen M, Christensen R, Klokker L, et al. Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee: a randomized clinical trial. JAMA Intern Med. 2015;175(6):923-930. doi:10.1001/jamainternmed.2015.0461
Hsu H, Siwiec RM. Knee Osteoarthritis .2019 Available from: https://www.ncbi.nlm.nih.gov/books/NBK507884/
Kolasinski, S. L., Neogi, T., Hochberg, et al. (2020, Feb). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care and Research, 72(2), 149-162. https://doi.org/10.1002/acr.24131
Kon, E., Filardo, G., Drobnic, M., et al. (2012). Non-surgical management of early knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 20, 436-449.
Michael JW, Schlüter-Brust KU, Eysel P. The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee . Deutsches Arzteblatt International. 2010 Mar;107(9):152.
Migliorini F, Driessen A, Quack V, et al. Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis. Arch Orthop Trauma Surg. 2021;141(9):1473-1490. doi:10.1007/s00402-020-03551-y
Moretti L, Maccagnano G, Coviello M, et al. Platelet Rich Plasma Injections for Knee Osteoarthritis Treatment: A Prospective Clinical Study. J Clin Med. 2022;11(9):2640. Published 2022 May 8. doi:10.3390/jcm11092640
Nedunchezhiyan, U., Varughese, I., Sun, A. R., et al. (2022). Obesity, inflammation, and immune system in osteoarthritis. Frontiers in immunology, 13, 907750.
Ross, A., Gascon, G. M., Snow, R., et al. (2020). Outcomes of a conservative care program for knee osteoarthritis through translation of research into practice. Musculoskeletal Care, 18(3), 342-351.
Tong, B., Chen, H., Wang, et al. (2024). Clinical prediction models for knee pain in patients with knee osteoarthritis: a systematic review. Skeletal Radiology, 53(6), 1045-1059.
Wei P, Bao R. Intra-Articular Mesenchymal Stem Cell Injection for Knee Osteoarthritis: Mechanisms and Clinical Evidence. Int J Mol Sci. 2022;24(1):59. Published 2022 Dec 21. doi:10.3390/ijms24010059

Benign Paroxysmal Positional Vertigo

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 01 Oct 2024 22:28:52 GMT

BPPV is a common, treatable, cause of dizziness.

Imagine you roll over in bed, stand up from a chair, or turn to look behind you, and suddenly you feel that the room is spinning around you. It feels like the whole world is moving, or you’re moving even though you know you are not. You might feel sick or even throw up.

This feeling is called vertigo, which is the sensation of motion of either yourself or your surroundings in the absence of true motion.

Vertigo is a symptom of a number of different conditions. But the most common cause is Benign Paroxysmal Positional Vertigo, referred to as BPPV .

A little bit of anatomy

BPPV occurs due to a problem with the vestibular system of your inner ear. So, to understand why it occurs it helps to understand how this system normally functions.

The vestibular system is found in the inner ear and is made up of three semi-circular canals and two otolith organs. The job of the whole system is to monitor the movement of your head. The semi-circular canals monitor rotation (nodding and shaking your head), and the otolith organs monitor movement in a straight line (like stopping suddenly on your bike).

Messages from the vestibular system are sent along the vestibular nerve to your brain, where they help to

coordinate movement of your eyes and to maintain balance.

In BPPV, fluid within the canals forms crystals called otoconia . These crystals disturb the normal messages sent to the brain, which causes vertigo.

Who gets it?

About 1 in 50 people will experience BPPV over their lifetime. It is more common in women than men, especially between the ages of 50-70. Although it is not caused by a serious medical condition, the symptoms can reduce quality of life and lead to harmful falls.

It is not known why BPPV occurs but having osteoporosis or a recent head trauma are risk factors.

Diagnosing BPPV

Diagnosis of BPPV is a clinical diagnosis which means there is no scan or blood test. Your physiotherapist will listen carefully as you describe your symptoms. Typically, vertigo caused by BPPV is related to movement of the head and lasts less than two minutes.

Your physio will assess your eye movements, ask you to move between positions to check for symptoms, and perform specific movement tests which have high accuracy for making a BPPV diagnosis.

Treatment

Luckily there are very effective treatments for BPPV. Carefully moving through a sequence of positions can clear out the crystals in the canal. These techniques can significantly improve symptoms the first time they are completed, but sometimes need to be repeated, and it is important that they are done correctly. Depending on your problem you may also be prescribed exercises to help improve your balance.

Many people with BPPV can have complete resolution of symptoms within 1-2 visits. For some, it may take longer.

Take home Advice

BPPV can cause serious symptoms and lead to harmful falls. It is caused by crystal formation within the inner ear and mostly affects people in their 50s-70s. It is important to have vertigo assessed by a qualified health professional as there are multiple conditions which may be the cause. Fortunately, BPPV can be diagnosed without any invasive tests and can often be treated successfully quite quickly.

Got vertigo and want to get it sorted? Give us a call.

At Movement for Life Physiotherapy, we can assess, diagnose, and treat vertigo and provide you with a comprehensive treatment plan to help get you back to the things you love doing sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References:

Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W., Do, B. T., Voelker, C. C., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 156(3_suppl), S1–S47. https://doi.org/10.1177/0194599816689667
Chen, J., Zhao, W., Yue, X., & Zhang, P. (2020). Risk Factors for the Occurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Frontiers in neurology, 11, 506. https://doi.org/10.3389/fneur.2020.00506
Power, L., Murray, K., & Szmulewicz, D. J. (2020). Characteristics of assessment and treatment in Benign Paroxysmal Positional Vertigo (BPPV). Journal of vestibular research : equilibrium & orientation, 30(1), 55–62. https://doi.org/10.3233/VES-190687

World Physical Therapy Day 2024

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 04 Sep 2024 08:13:33 GMT

Physiotherapists provide expert advice, guidance and treatment for low back pain.

World PT Day is observed to generate awareness about the crucial contribution physiotherapists make to society, enabling people to be mobile, well, and independent. This is observed annually on the 8th September. Designated in 1996, World PT Day is promoted by World Physiotherapy .

The focus for this year’s World PT Day on 8 September is low back pain and the crucial role physiotherapists

play in its management and prevention.

The big picture

Low back pain (LBP) is a big problem. Affecting approximately 10% of the population worldwide, it often leads to psychological distress and a poorer health-related quality of life. In Australia, around 4 million people, or 16% of the of the population, are estimated to be living with back pain at any one time. It is the third leading cause of disease burden overall, at a annual cost of about $3.4 billion (2020-2021), representing 2.2% of total health expenditure and 23% of expenditure for all musculoskeletal problems.

Worldwide the incidence of LBP is escalating, particularly in low-income and middle-income countries. In 2020 studies estimated that about 10% of the worlds population suffered from LBP, accounting for 8.1% of all-cause years lived with disability globally. Low back pain is commonly associated with other conditions, particularly mental and behavioural conditions, arthritis, and asthma, and is the main reason for premature exit out of the workforce. Its higher prevalence in low and middle-income populations means it often co-exists with higher rates of diabetes, cardiovascular disease, and cerebrovascular disease.

For an overview of low back pain, click here .

Economic and societal burden

Despite being a leading cause of disability worldwide and a major cause for exit from the workforce, low back pain remains poorly understood and a low priority for governments and health policy makers world wide.

Consider the following:

In Australia, low back pain is the leading cause of disability burden , lost work productivity and early retirement. Studies have shown that physiotherapy-led cognitive functional therapy for chronic disabling LBP, on average, reduced the cost of LBP treatment by $5,000 per year for every patient, mostly through getting people back to work.
In Brazil, LBP accounted for 100 days absent from work per person between 2012 and 2016 . The productivity losses accounted for nearly 80% of the country's annual cost of LBP of US$2.2 billion.
In the UK, the cost of LBP from GP appointments alone is estimated at £5 billion annually . The introduction of a stratified care approach, STarT Back , has significantly decrease disability from back pain, reduced time off work and saved money by making better use of health resources. The return on investment of STarT Back is estimated at £226 for every £1 spent to implement it.
In the USA in 2016, back and neck pain cost US$134 billion . Early physiotherapy treatment over usual care resulted in an average net benefit of US$4,160 per person.

What works for low back pain?

It is now well recognized that a patient-centred biopsychosocial approach to the treatment and management of low back pain leads to the best outcomes for individuals. Recommended non-surgical interventions include:

Education programs that support knowledge and self-care strategies
Exercise programs
Judicious and timely use of physiotherapy interventions such as manual therapy
Psychological therapies such as congnitive behavioural therapy
Medicines such as non-steroidal anti-inflammatory medicines

Working as part of a collaborative, multi-disciplinary team ideally places physiotherapists as the rehabilitation specialists for the management of low back pain.

What's NOT recommended

Research into the treatment and management of low back pain has made significant progress over the past decade, and the evidence is mounting against low-quality treatment approaches and interventions. It is important to recognize that while some of the following may provide some clinical improvement in some cases, they should not replace treatment strategies with proven effectiveness.

The following treatments are now NOT recommended for low back pain:

Traction
Therapeutic ultrasound
transcutaneous electrical nerve stimulation (TENs)
Orthotics
Assistive products including lumbar braces, belts and supports, and mobility assitive products
Mindfulness-based stress reduction therapy
Opiod analgesics
Anti-depressants
Skeletal muscle relaxants
Glucocorticoids
Benzodiazepines
Injectible local anaesthetics
Weight management
Paracetamol
Spinal injections
Spinal fusion
Disc replacement

Sources: WHO (2023), National Institute for Health and Care Excellence (2020), Wewege et al. (2023).

The role of Physiotherapy

Physiotherapy plays a crucial role in the treatment and management of low back pain. In Australia, physiotherapists are primary care practitioners. This means they are able to assess and diagnose their patients within their scope of practice. Physiotherapist's are an integral part of a multi-disciplinary health care team, working closely with doctors, specialists, radiologists, pharmacists, psychologists, and other allied health professionals to optimise the treatment and mangement of low back pain. Their breadth of training and experience enables them to assess low back pain, gauge the impact of symptoms on functional capacity, and effectively guide patients on how to keep active and manage symptoms, and reduce the risk of future episodes of LBP.

The clinical care standard for low back pain includes:

An initial clinical assessment that includes a psychosocial assessment to guide management
Education and advice on staying active and returning to usual activity, including work, as soon as possible.
Education and advice on self management strategies, including prescribed exercise and progressions.

Regular physical activity and exercise are important in the management of low back pain. Evidence informed research and clinical experience has clearly demonstrated the importance of staying active and keeping moving both during and following an episode of low back pain. Physiotherapists are well placed to prescribe, modify, and progress therapeutic exercise, adjust daily activity levels, set achievable personal goals, and help you find the right balance between rest and activity.

The value of walking

It is estimated that 70% of people who experience low back pain will have a recurrence within 12 months. A recent Australian study, titled the WalkBack trial for low back pain , looked at the impact of a progressive walking program on prevention of low back pain. The study, a randomized controlled study, included 701 participants (351 in the intervention group, 350 in the control group) who had recently recovered from an episode of low back pain. Participants in the intervention group received 6 sessions of physiotherapy over a 6 month period, which involved education about our current understanding of LBP, reassurance, and advice regarding a tailored, progressive walking program. Participants in the control group were provided with usual care (which is usually no care), though they were free to seek out treatment or prevention strategies as required.

At the conclusion of the study, the researchers found a statistically significant reduction (28%) in the risk of recurrence. The median days to recurrence was 208 days in the intervention group compared to 112 days in the control group. The intervention was found to be cost-effective, with a reduction in work absenteeism the largest financial benefit.

The take home

The challenge of managing the increasing global burden of low back pain requires a commitment from government and policy makers to change how care is delivered, and the courage of health care professionals to challenge old fashioned models of care for low back pain. Through education and evidence-backed advice, physiotherapists have the opportunity to dispel many of the myths surrounding the management of low back pain, reduce the economic imact of this condition and improve outcomes for clients.

Have you got low back pain or recently recovered from an episode of low back pain? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and specialists and offer a range of

physiotherapy services to help you manage your low back pain symptoms.

Call now on 08 8945 3799 or book online.

For more evidence based information on low back pain, visit Australian Physiotherapy Association and follow the social media campaigns using #WorldPTDay .

Sources.

Australian Physiotherapy Association. Low back pain clinical care standard. https://australian.physio/research/prf/translation/low-back-pain-clinical-care-standard. Accessed 4th September 2024.
Bugeja, B. (2024). WalkBack trial for low back pain. Australian Physiotherapy Association. https://australian.physio/inmotion/walkback-trial-low-back-pain
Cieza, A., Causey, K., Kamenov, K., Hanson, S. W., Chatterji, S., & Vos, T. (2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 396(10267), 2006-2017.
Ferreira, M. L., De Luca, K., Haile, L. M., Steinmetz, J. D., Culbreth, G. T., Cross, M., ... & Mahmoodpoor, A. (2023). Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. The Lancet Rheumatology, 5(6), e316-e329.Hill, J. C., Whitehurst, D. G., Lewis, M., Bryan, S., Dunn, K. M., Foster, N. E., ... & Hay, E. M. (2011). Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. The Lancet, 378(9802), 1560-1571.
Kent, P., Haines, T., O'Sullivan, P., Smith, A., Campbell, A., Schutze, R., ... & Hancock, M. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet, 401(10391), 1866-1877.
Kosakowski, H., Rone-Adams, S., Boissonnault, W. G., Harmon-Matthews, L., Kuczynski, J. J., Martin, M., & Briggs, M. S. (2024). Financial impact associated with implementation of the low back pain clinical practice guideline in outpatient physical therapist practice at a large academic medical center. Physiotherapy Theory and Practice, 40(4), 746-754.
Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.
National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management. https://www.nice.org.uk/guidance/ng59. Accessed 4th September 2024.
O'Keeffe, M., O'Sullivan, P., Purtill, H., Bargary, N., & O'Sullivan, K. (2020). Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). British journal of sports medicine, 54(13), 782-789.
Sharma, S., & McAuley, J. H. (2022). Low back pain in low-and middle-income countries, part 1: the problem. journal of orthopaedic & sports physical therapy, 52(5), 233-235.
Sharma, S., Pathak, A., Parker, R., Costa, L. O. P., Ghai, B., Igwesi-Chidobe, C., ... & McAuley, J. H. (2024). How Low Back Pain is Managed—A Mixed-Methods Study in 32 Countries. Part 2 of Low Back Pain in Low-and Middle-Income Countries Series. journal of orthopaedic & sports physical therapy, 54(8), 560-572.
STarT Back Screening Tool, Keele University.
The Global Epidemic of low back pain. The Lancet Rheumatology. June 2023. DOI: 10.1016/S2665-9913(23)00133-9
Vibe Fersum, K., O'Sullivan, P., Skouen, J. S., Smith, A., & Kvåle, A. (2013). Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial. European journal of pain, 17(6), 916-928.
Wewege, M. A., Bagg, M. K., Jones, M. D., Ferraro, M. C., Cashin, A. G., Rizzo, R. R., ... & McAuley, J. H. (2023). Comparative effectiveness and safety of analgesic medicines for adults with acute non-specific low back pain: systematic review and network meta-analysis. Bmj, 380.
World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization.

Women's Health Week 2024

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 02 Sep 2024 05:09:36 GMT

Make your health a priority

At Movement for Life Physiotherapy, we believe in the physical and emotional health and well being for every Australian woman throughout their lifetime. Whether it's about encouraging young women to get involved in sport, assisting mum's-to-be to keep active and strong during their pregnancy, or assisting women to recover from a cancer diagnosis, we're here to help you unlock your powers for good health.

This year, Women's Health Week is shining the spotlight on some of the biggest issues in women's health under the banner of 'Your voice. Your choice'. It's all about connecting women to valuable resources and supporting women to make informed decisions about their health with information that's easy to understand.

We've categorised links below to some relevant websites and resources that can assist with making informed health care choices. And we are continuing to develop relevant, evidence-informed blogs on Women's Health to help you stay healthier, get moving again and reduce your risk of injury.

If you need a physiotherapist, give us a call on 08 8945 3799 or click on Book An Appointment. We're here to help.

Resources for First Nations People

Bowel and Gut Health

Heart Health

Bone Health

Know you bones - Online Assessment Tool

Mental Health

Beyond Blue - Wellbeing Action Tool

Breast and Pelvic Health

Polysystic Ovary Syndrome
Polycystic Ovary Syndrome symptom checklist
The Screen Podcast
Breast/Chest Screening for trans and gender diverse people

Other Websites:

Iliotibial Band Syndrome

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 27 Aug 2024 07:11:21 GMT

Client-centered treatment is key to a successful return to sport following ITB Syndrome

Iliotibial Band Syndrome (ITB Syndrome) is a common overuse injury affecting the lateral, or outside, part of the knee. It is common in people who run recreationally and competitively, and can be present across the spectrum of sports, from athletics, AFL and soccer, to basketball, netball and hockey. A non-traumatic overuse injury, ITB syndrome is often concomitant with underlying weakness of the hip abductor muscles, which results in altered lower limb biomechanics and compression of tissue on the outside of the knee during the foot strike and early stance phase of running.

A little bit of anatomy

The iliotibial band (ITB) is a thick, tough, durable band of connective tissue that runs along the outside of the thigh, from the pelvis to just below the knee joint. An extension of the tensor fascia latae and gluteus maximus muscles, the ITB is comprised of collagen fibers that provide stability to the knee and hip joints during movement. It is named in reference to its origin and insertion points – it originates from the iliac crest of the pelvis and inserts into the lateral condyle of the tibia just below the knee.

Nerd fact: The ITB inserts into the tibia at Gerdy’s tubercle, a smooth facet of bone named after the French surgeon

Pierre Nicolas Gerdy (1797-1856). The common peroneal nerve runs just behind it which, if damaged, results in foot drop.

During the foot strike and early stance phase of the running cycle, the gluteal muscles contract eccentrically to decelerate the leg, resulting in tension in the ITB and compression across the lateral knee joint. Under abnormal conditions, and with repetition, this activity can inflame and irritate the underlying adipose (fatty) tissue between Gerdy's tubercle and the lateral femoral epicondyle , resulting in pain, discomfort and restriction in activity.

Who gets it?

ITB syndrome is most seen in persons undertaking high repetition lower limb loading activities – think runners, cyclists, and people training for sports that require these motions.

It is estimated to affect up to 14% of people who run regularly and is more prevalent in males (50-81%) than females (16-50%).

The causes of ITB syndrome are multifactorial and include both intrinsic factors such as hip and foot biomechanics, hip muscle weakness and muscle imbalances, and extrinsic factors including running load, running surface, and footwear. In most (but not all) cases, these factors have been present for a prolonged period with the development of lateral knee pain the key driver for seeking advice and treatment.

Diagnosing ITB Syndrome

ITB Syndrome can be diagnosed clinically by a physiotherapist. The presenting signs and symptoms and history of pain and activity are often suggestive of ITB syndrome, which can be confirmed with a battery of physical tests. In the presence of ITB syndrome, palpation over the lateral aspect of the knee while performing loaded knee flexion will often reveal crepitus and/or pain. Restricted hip joint range of motion and gluteal weakness are common findings, while foot examination may reveal contributing biomechanical issues.

It is important to consider and rule out several other possible diagnoses to ensure the correct course of management is taken. These include injury to the lateral collateral ligament, lateral meniscus injury, osteoarthritis, and referred pain from the lumbar spine to name a few.

Radiological investigations are generally not indicated for a diagnosis of ITB syndrome. In the presence of more complex history or in recalcitrant cases, X-ray, MRI and/or ultrasound may be useful to confirm the diagnosis and plan future management.

Treatment

The mainstay of treatment for ITB syndrome involves client-centered physiotherapy. Effective treatment involves a combination of load management, manual therapy, and strengthening and stretching to reduce pain, improve joint range of motion, and correct biomechanical issues.

The early phase of treatment for ITB syndrome can be frustrating as physical activity loads are adjusted to a threshold below pain. It is important that this is titrated appropriately to avoid unnecessary deconditioning.

The aim is to find a level and type of activity that can be undertaken that maintains fitness without provoking pain,

and implementing a progressive exercise program off this baseline.

During the early phase, soft tissue techniques, dry needling, and manual therapy are useful to reduce pain, release tightness in surrounding muscles and fascia, and improve hip joint mobility. Early strengthening is critical to address muscle weakness and imbalances. Individual assessment and feedback on running biomechanics and sport-specific movement patterns form an important component of the recovery from ITB syndrome.

As symptoms improve, strength and endurance-based exercises can be progressed, and a gradual return to sport managed. Load progression must be done gradually, with close attention paid to the presence of lateral knee pain and biomechanical changes when fatigued. Failure to manage and address these will ultimately result in recurrence of symptoms and delayed return to sport.

Other interventions that may be helpful include foam rolling, kinesiology taping, and the prescription of orthotics. Over the counter non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended by a doctor or pharmacist for short-term pain relief.

Will a steroid injection help? What about surgery?

Studies investigating the effectiveness of cortisone (steroid) injections for ITB syndrome have not found superior long-term outcomes when compared to physiotherapy. While steroid therapy can be effective at reducing pain in the short-term, cortisone has been found to be detrimental to the structure of tendon tissue and increase the risk of degenerative rupture. While this risk can be managed, cortisone therapy is generally only recommended in cases where persistent pain is hampering rehabilitation progression and impacting health-related quality of life.

Open and arthroscopic surgery has been shown to be effective for returning athletes to sport in 81-100% of cases studied. While previously considered a 2 ^nd line treatment option, given the challenges that can present managing some cases conservatively, there is a strong argument that, for some individuals, early surgery followed by physiotherapy-led rehabilitation may reduce time lost from sport participation. We recommend discussing this with your physiotherapist and referral to an orthopaedic surgeon where indicated.

How long does it take to recover?

ITB syndrome has a good prognosis, particularly if it is identified early and appropriate client-centered treatment initiated promptly. While most cases resolve within 6 – 12 weeks, the length of time to return to sport is dependent on the duration and severity of symptoms on initial presentation, complexity of factors contributing to the development of symptoms, and individual response to early phases of management. Some cases can take many months to resolve, while occasionally symptoms persist for years.

Commitment to therapy and diligence with exercises, combined with close adherence to prescribed

load and pain management strategies, are crucial for a successful outcome.

Take home Advice

Iliotibial band syndrome is a common injury that predominantly affects runners and running based athletes, characterized by pain on the outside of the knee. The best initial course of treatment involves physiotherapy-led load management, manual therapy, lower-limb stretching, and hip strengthening exercises. Surgery followed by physiotherapy may be indicated, particularly with more severe and/or prolonged symptoms. Early intervention and diligence with physiotherapy are crucial for a successful outcome. With appropriate client-centered treatment, most people can expect to return to sport within 6-12 weeks.

Are you getting knee pain when you run? Feel tight through your ITB? Give us a call.

At Movement for Life Physiotherapy, we can assess your ITB, diagnose what's causing ITB syndrome, and provide you with a comprehensive treatment plan to help get you back to the things you love doing sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References:

Bolia, I. K., Gammons, P., Scholten, D. J., Weber, A. E., & Waterman, B. R. (2020). Operative versus nonoperative management of distal iliotibial band syndrome—where do we stand? A systematic review. Arthroscopy, sports medicine, and rehabilitation, 2(4), e399-e415.
Friede, M.C., Innerhofer, G., Fink, C., Alegre, L. M. & Csapo, R. Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals? (2022). Physical Therapy in Sports. 54, 44-52. https://doi.org/10.1016/j.ptsp.2021.12.006
Gupta, P.W.C., Yadav, D.C., Singh, K.K W., Bhattacharjee, S.C. Iliotibial Band Friction Syndrome: A Common Cause of Lateral Knee Pain in Long-Distance Runners. (2023). Journal of Marine Medical Society, 25(1):p 69-72. DOI: 10.4103/jmms.jmms_49_22
McKay, J., Maffulli, N., Aicale, R. et al. Iliotibial band syndrome rehabilitation in female runners: a pilot randomized study. J Orthop Surg Res 15, 188 (2020). https://doi.org/10.1186/s13018-020-01713-7
Pegrum J, Self A, Hall N. Iliotibial band syndrome. (2019). BMJ, 364 :l980. Doi:10.1136/bmj.l980
Physiopedia (2024). Iliotibial Band Syndrome. https://www.physio-pedia.com/Iliotibial_Band_Syndrome
Stickley, C. D., Presuto, M. M., Radzak, K. N., Bourbeau, C. M., & Hetzler, R. K. (2018). Dynamic Varus and the Development of Iliotibial Band Syndrome. Journal of athletic training, 53(2), 128–134. https://doi.org/10.4085/1062-6050-122-16

The Ankle - Syndesmosis (High) Ankle Injury

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 22 Jul 2024 07:20:27 GMT

High ankle sprains are complex and require skilled input to rehabilitate effectively and return to sport.

Sprained your ankle? See why we're recommending hydrotherapy for higher grade ankle injuries.

Ankle sprains are the most common musculoskeletal injury worldwide, so there is a good chance most of us will experience at least one ankle injury during our lifetime. Most of these will impact the outside of the ankle, called a lateral ligament sprain. More complex sprains of the ankle can involve a structure called the syndesmosis, and these can be difficult to diagnose and more challenging to rehabilitate. Read on to learn a little more about syndesmosis injuries and how they get the name ‘high ankle sprain’.

A little bit of anatomy

A syndesmosis is defined as a fibrous joint between two adjacent bones, held together by a strong membrane and ligaments. The tibiofibular syndesmosis sits just above the ankle joint (thus why it's referred to as a 'high' ankle sprain) and consists of...yep you may have guessed it...the tibia on the inside and the fibula on the outside. The main ligaments holding the syndesmosis together are the inferior tibiofibular ligaments (there’s an anterior one and a posterior one) and the lower fibers of the interosseous membrane. On the inside of the ankle is the super strong deltoid ligament, while on the outside there are a few ligaments, namely the anterior talofibular ligament, calcaneofibular ligament and the posterior talofibular ligament. Collectively these ligaments, along with the muscles in this region, provide stability to the ankle joint and allow the foot to adjust to the surfaces underneath and produce power for locomotion.

Who gets it?

Syndesmosis injuries represent up to 18% of all ankle sprains in the general population but spike to 32% in athletic populations. They often involve tears in the ligaments connecting the tibia and fibula, leading to instability. These injuries usually occur when the foot forcefully rotates outward while the ankle is bent upward and the foot turned inward, potentially damaging inner ligaments. Factors like excessive foot bending or twisting can contribute and they're sometimes part of a more complex fracture pattern called Maisonneuve fracture.

Diagnosing high ankle sprain

Patients with syndesmosis ligament injuries often report a history of ankle trauma. Common symptoms include pain in the front part of the ankle during weight-bearing, worsened by rotating the foot outward and pulling it upward. Signs include feelings of ankle instability, tenderness, swelling, and difficulty bending the foot upward, with recurring swelling in the joint. Chronic cases may involve pain in the front and outer part of the ankle, frequent swelling, instability/giving way, and sometimes stiffness.

Diagnosis involves comparing the injured ankle to the unaffected one and performing specific physical

tests like external rotation, squeeze test, Cotton, and fibular translation tests.

These tests help detect pain, instability, or abnormal movement patterns and help determine whether a syndesmosis injury is present or whether symptoms are caused by something else, such as a lateral ankle sprain, ankle fracture or tendon injury.

Do I need a scan?

X-rays are usually indicated when a high ankle sprain is suspected and can be ordered by your physiotherapist. Syndesmosis injuries require significant force, and fractures need to be considered as part of the differential diagnosis. Xray can also assist with determining if surgical intervention is required or if the injury can be managed conservatively.

In some circumstances, other imaging techniques can be beneficial. Ultrasound and weight bearing CT scans can evaluate the ankle’s stability, comparing both sides for subtle differences in bone position under stress. MRI, while being highly sensitive for certain ankle injuries, may not clearly show syndesmosis instability without additional functional tests.

Treatment

When managing syndesmosis injuries, treatment depends on ankle stability. For stable cases with bones well-aligned the PEACE and LOVE principle is used.

An immobilizing brace can be used to limit rotation, and activity is often restricted for four to six weeks.

Physiotherapy is crucial in the management and rehabilitation of high ankle injuries. Physiotherapy aims to optimize healing by restoring joint function, reducing pain, improving mobility, and enhancing ankle stability, helping patients regain activity levels and reducing long-term complications like chronic instability or joint degeneration.

Early phase rehabilitation utilises manual and soft tissue therapies to reduce pain and swelling, and restore joint mobility. Dry needling can be beneficial to redruce muscle tension and pain. Hydrotherapy is a great exercise medium in the early stages, offering gentle resistance for improved ankle mobilization and strengthening, and reducing swelling via increased hydrostatic pressure.

Graded therapeutic exercise programs, tailored by physiotherapists, start with basic

exercises for ankle mobility, proprioception and balance.

These are progressed to include functional exercises mimicking daily or sports activities, improving strength, agility and power, and thereby reducing the risk of a recurrent injury.

Will I need surgery?

Surgery is indicated for acute first-time injuries if disruption of the joint space is significant (high grade) and/or there is a fracture present that requires surgical fixation. Surgery may also be considered in some chronic and recurrent cases where conservative management has failed. Surgery usually entails screw fixation to stabilize the syndesmosis, followed by a period of limited weight bearing and rehabilitation. In many cases the screw is removed later when healing is complete.

How long’s it going to take?

The outlook for syndesmosis injuries depends on whether the injury is recent (acute) or persisting (chronic), and if it’s a first-time injury or recurrence of a previous ankle injury. Low to moderate grade acute injuries can heal well if treated promptly and diligently, allowing most patients to return to sports in approximately 6-12 weeks.

Chronic cases, where symptoms have been present for over six months, and/or recurrent injuries, often indicates more complex issues.

These presentations may require surgical intervention to stabilize ligaments, resulting in a prolonged recovery and rehabilitation period lasting 4-6 months.

The Take Home

Ankle syndesmosis injuries vary in severity and require careful diagnosis and treatment. They affect the ligaments between the tibia and fibula bones that are crucial for ankle stability. Athletes and dancers are especially prone to these injuries due to intense physical activity. Diagnosis involves comparing both ankles and using various clinical and radiological tests. Treatment ranges from conservative management for stable injuries to surgery for more complex cases. Physiotherapy plays a vital role, focusing on early restoration of ankle movement and strength, functional rehabilitation, and return to sport. Early intervention is crucial for better outcomes, ensuring a quicker return to normal activities.

Injure your ankle and not sure what to do? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your ankle pain and let you know whether you have a high ankle sprain, lateral ankle sprain, tendon injury, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Calder JD, Bamford R, Petrie A, McCollum GA (2016) Stable versus unstable grade II high ankle sprains: a prospective study predicting the need for surgical stabilization and time to return to sports. Arthroscopy 32(4):634–642
Hannon, C. P., Weber, D. C., & Golano, P. (2013). Treatment of chronic syndesmotic injury: A systematic review and meta-analysis. Foot & Ankle International, 34(4), 602-610. Retrieved from https://www.researchgate.net/profile/Charles-Hannon/publication/236339290_Treatment_of_Chronic_Syndesmotic_Injury_A_Systematic_Review_and_Meta-Analysis/links/55b8edfb08aed621de08046a/Treatment-of-Chronic-Syndesmotic-Injury-A-Systematic-Review-and-Meta-Analysis.pdf
Hermans, J. J., Beumer, A., de Jong, T. A., & Kleinrensink, G. J. (2010). Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. Journal of anatomy, 217(6), 633–645. https://doi.org/10.1111/j.1469-7580.2010.01302.x
Rellensmann, K., Behzadi, C., Usseglio, J. et al. Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies. Knee Surg Sports Traumatol Arthrosc 29, 1516–1522 (2021). https://doi.org/10.1007/s00167-020-06141-y
Saad, T. A. (2020). Comparative study between syndesmotic and suprasyndesmotic technique in syndesmotic ankle injury. Journal of Arthroscopy and Joint Surgery, 7(2), 91-97.
https://www.orthobullets.com/foot-and-ankle/7029/high-ankle-sprain-and-syndesmosis-injury

The Shoulder - Glenohumeral Joint Osteoarthritis

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 11 Jul 2024 08:23:18 GMT

As the population ages, the global disease burden of shoulder joint osteoarthritis will increase.

Shoulder (glenohumeral) joint osteoarthritis (OA) is one of the most common causes of shoulder pain among older people and like other forms of OA, it can be debilitating with respect to pain, restricted joint motion and impaired functional ability. A degenerative, multifactorial joint condition, OA of the shoulder is the third most common joint requiring surgical reconstruction (behind the knee and hip). Many different treatment options exist including conservative, pharmacological and surgical, and are largely dictated by patient age, severity of symptoms, findings on x-ray and comorbidities of the individual.

A little bit of anatomy

The shoulder or glenohumeral joint is an unstable, shallow, ball and socket joint, often described as a golf ball (the head of the humerus) sitting on a tee (the glenoid socket). The joint requires both static and dynamic stabilisers for effective shoulder function. The static constraints include the glenohumeral ligaments, glenoid labrum, and the joint capsule, and the dynamic constraints include the rotator cuff and scapular muscles.

Both the head of the humerus (the ball) and the glenoid fossa (the socket) are lined with softer chondral cartilage . This provides a smooth surface for joint movement and, in healthy shoulders, is effective at distributing force and load across the joint.

Osteoarthritis affects all the structures of the joint including the ligaments, nerves, and muscles, but mainly the articular cartilage.

Normally, there is a balance between the body making new cartilage to replace older cartilage. In osteoarthritis this balance is impacted, affecting the amount of healthy cartilage. Pain arises from changes to surrounding tissues, particularly the joint capsule, which becomes sensitive and tight. Progressive cartilage and eventually bone loss, joint space narrowing and muscle weakness impact biomechanics of the joint result in notable dysfunction, disability and healthcare costs.

Who gets it?

Primary shoulder OA represents a spectrum of disease , with factors such as mechanical trauma (injury, fracture, dislocation), comorbidities (obesity, inflammation), and intrinsic factors (age, genetics, gender) all contributing to its development. has no specific causative factor. It can occur over a broad age range, though is most seen in patients older than 60 years of age and is more common in women.

Studies from the USA indicate that shoulder arthritis affects about a third of world’s population over 60 years of age, and up to 94% of men and women over the age of 80..

Obesity remains one of the most important risk factors for the incidence and progression of osteoarthritis. An Australian study found that obese females aged 55-64 with shoulder joint OA were 8.6 times more likely to receive joint replacement surgery compared to their normal weight counterparts. For males the likelihood was 2.5 times greater.

If you have a history of shoulder joint injury, are overweight, and aged over 60, you have an increased risk of developing shoulder joint OA.

What happens?

Over time, chondral cartilage becomes thinner and wears. This is a normal part of the ageing process and for many people presents no issue. In some cases, particularly if there has been previous shoulder trauma and/or surgery, or in the presence of comorbidities (eg. obesity, inflammatory conditions), osteoarthritis can develop. This is characterized by progressive cartilage loss, adaptive changes to the subchondral bone, and abnormal bone formation (called osteophytes). These changes affect the shape and biomechanics of the shoulder, resulting in narrowing of the joint space and shoulder joint instability. The combined effect of this is further cartilage damage and, eventually, subchondral bone loss.

Diagnosing shoulder OA

Shoulder osteoarthritis can be clinically diagnosed by a physiotherapist. A thorough interview will often identify key factors in the past and current history that correlate with osteoarthritis. Patient reported symptoms including gradual onset pain, which may or may not be present at rest, and difficulty with activities of daily living such as personal hygiene, dressing and hanging washing. Movement may be accompanied by crepitus (crunching, grinding sensation).

Signs of osteoarthritis include loss of range of motion in multiple directions, shoulder instability, weakness of the rotator cuff muscle group, and shoulder blade (scapula) dysfunction. A battery of tests to assess these structures will assist in making a diagnosis of shoulder OA.

What else could it be?

There are a variety of conditions that present with similar symptoms and signs to shoulder osteoarthritis. These include rotator cuff tendonitis, rotator cuff tears , subacromial impingement , and frozen shoulder . Subtle differences in the behaviour of these conditions help us to determine the primary cause of your symptoms and treat it effectively.

Do I need a scan?

Scans are generally not recommended for diagnosing osteoarthritis. One of the reasons for this is that what is seen on a scan does not normally match very well with a person’s symptoms, and generally will not change the recommended management. A scan is only required if you have an atypical presentation, or if surgery might be indicated, which is a small percentage of people. Your physio will work with you to decide whether a scan is necessary.

Treatment

Exercise is the number one treatment for osteoarthritis and should be the first line of treatment for all patients . This could include specific strengthening exercises or mobility exercises, or hydrotherapy. Often when getting started with exercise pain can initially flare up. Non-opioid pain medication can provide short term pain relief and improvements in function which in turn can improve participation in therapeutic exercise. You can discuss this approach with your physiotherapist to get the right balance.

The goal of physiotherapy is to decrease pain, increase shoulder ROM, improve shoulder and upper limb function,

and protect the shoulder joint from further damage.

Shoulder range of motion is frequently limited in multiple directions in people with shoulder OA. The cause of this can be multifactorial, including pain, decreased soft tissue flexibility, and joint deformity related to OA. Likewise pain and subsequent disuse can result in progressive muscle weakness. Studies have demonstrated that the rotator cuff muscle group is primarily affected in shoulder OA, adversely affecting shoulder and scapula movement patterns.

Physiotherapists utilise a range of interventions to address these impairments including soft tissue and manual therapy, joint mobilization, stretching, and therapeutic exercise. Strengthening of the rotator cuff muscle group and scapula stabilisers is critical and forms an important component of the early stages of shoulder OA management. For an example exercise program, click here .

While not a weight-bearing joint, shoulder joint OA may benefit from weight loss if you are overweight. Obesity doubles the lifetime risk of symptomatic osteoarthritis compared to individuals with a lower BMI. Studies have demonstrated that factors related to obesity – adipose deposition, insulin resistance, and altered immune responses – may lead to the initiation and progression of obesity-associated OA. Weight loss can be difficult and there are multiple factors involved in a person’s weight. Your physiotherapist can support you in planning if this is a priority for you.

Should I get a steroid injection?

Most studies on injectable therapies have been conducted in people with hip or knee osteoarthritis, or on different causes of shoulder pain. However, there are some options which can be considered. It is important to recognize that injections are an invasive technique, and as such carry an increased risk profile for complications including infection. You can click on the links below for more information:

What about surgery?

A small percentage of people will require joint replacement surgery. This is considered if the problem is not responding to other noninvasive treatments and is having a significant impact on quality of life.

Prior to considering surgery it is important that you have completed at least 3 months of a good quality exercise program.

This is the minimum timeframe necessary to ascertain the benefits of a non-surgical approach, to improve strength and shoulder joint biomechanics, and if indicated, to reduce weight. Failing this, your physiotherapist can provide guidance on available medical and surgical treatments, enabling you to make informed health care decisions.

How long’s it going to take?

Effective non-surgical management for mild to moderate shoulder OA requires long-term lifestyle changes, regular exercise, and physiotherapy to ensure sustainable outcomes are achieved. An initial 6-week phase of intensive physiotherapy is beneficial to facilitate reduction in pain, improve joint range of motion and design an appropriate exercise program. Commitment to regular exercise can help to maintain improvements and function, while ‘top up’ physiotherapy sessions (3-4 times per year) can be used to modify exercise programs and manage any persistent symptoms.

If surgery is indicated, then expect a period of 6-12 months to recover and rehabilitate back to a satisfactory functional capacity. Most people who opt for surgical management will see good improvements in pain, albeit with some loss of range of motion (though probably better than pre-surgery!).

The Take Home

Shoulder joint OA is one of the most common causes of shoulder pain in people aged over 55. In younger and/or athletic populations, or where mild to moderate osteoarthritis is present, management should focus on non-operative options, where a combined approach of activity modification and lifestyle changes, physiotherapy, and therapeutic exercise can be effective. Surgical intervention should only be considered as a last resort where pain and loss of function have failed to improve with conservative management and health-related quality of life is affected.

Got shoulder pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shoulder pain and let you know whether you have osteoarthiritis, frozen shoulder, a rotator cuff tear, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Al-Mohrej, O. A., Prada, C., Leroux, T., et al. (2022). Pharmacological treatment in the management of glenohumeral osteoarthritis. Drugs & Aging, 39(2), 119-128.
Australian Commission on Safety and Quality in Healthcare. (2024). Osteoarthritis of the Knee Clinical Care Standard. Retrieved October from https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard
Bannuru, R. R., Osani, M. C., Vaysbrot, E. E., et al. (2019, Nov). OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage, 27(11), 1578-1589. https://doi.org/10.1016/j.joca.2019.06.011
Deyle GD, Allen CS, Allison SC, et al. (2020). Physical Therapy versus Glucocorticoid Injection for Osteoarthritis of the Knee. N Engl J Med. 382(15):1420-1429. doi:10.1056/NEJMoa1905877
Familiari, F., Ammendolia, A., Rupp, M. C., et al. (2023). Efficacy of intra‐articular injections of hyaluronic acid in patients with glenohumeral joint osteoarthritis: A systematic review and meta‐analysis. Journal of Orthopaedic Research, 41(11), 2345-2358.
Fisher, C., Soh, S. E., Page, R. S., et al. (2023). Forecasting the future burden of primary total shoulder replacement in Australia. Osteoarthritis and cartilage, 31(12), 1636–1643. https://doi.org/10.1016/j.joca.2023.08.012
Henriksen M, Christensen R, Klokker L, et al. (2015). Evaluation of the benefit of corticosteroid injection before exercise therapy in patients with osteoarthritis of the knee: a randomized clinical trial. JAMA Intern Med. 175(6):923-930. doi:10.1001/jamainternmed.2015.0461
Ibounig, T., Simons, T., Launonen, A., & Paavola, M. (2021). Glenohumeral osteoarthritis: an overview of etiology and diagnostics. Scandinavian Journal of Surgery, 110(3), 441-451.
Hsu H, Siwiec RM. Knee Osteoarthritis .2019 Available from: https://www.ncbi.nlm.nih.gov/books/NBK507884/ \
Ibounig, T., Simons, T., Launonen, A., & Paavola, M. (2021). Glenohumeral osteoarthritis: an overview of etiology and diagnostics. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 110(3), 441–451. https://doi.org/10.1177/1457496920935018
Khazzam, M., Gee, A. O., & Pearl, M. (2020). Management of glenohumeral joint osteoarthritis. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 28(19), 781-789.
Kolasinski, S. L., Neogi, T., Hochberg, et al. (2020, Feb). 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care and Research, 72(2), 149-162. https://doi.org/10.1002/acr.24131
Kon, E., Filardo, G., Drobnic, M., et al. (2012). Non-surgical management of early knee osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 20, 436-449.
Michael JW, Schlüter-Brust KU, Eysel P. (2010) The epidemiology, etiology, diagnosis, and treatment of osteoarthritis of the knee . Deutsches Arzteblatt International. 107(9):152.
Michener, L. A., Heitzman, J., Abbruzzese, L. D., et al. (2023). Physical Therapist Management of Glenohumeral Joint Osteoarthritis: A Clinical Practice Guideline from the American Physical Therapy Association. Physical therapy, 103(6), pzad041. https://doi.org/10.1093/ptj/pzad041
Migliorini F, Driessen A, Quack V, et al. (2021) Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis. Arch Orthop Trauma Surg. 141(9):1473-1490. doi:10.1007/s00402-020-03551-y
Moretti L, Maccagnano G, Coviello M, et al. (2022) Platelet Rich Plasma Injections for Knee Osteoarthritis Treatment: A Prospective Clinical Study. J Clin Med., 11(9):2640. doi:10.3390/jcm11092640
Morgan, S. D., Wall, C. J., de Steiger, R. N., et al. (2023). Obesity is associated with an increased risk of undergoing shoulder arthroplasty in Australia. Journal of Shoulder and Elbow Surgery, 32(8), 1740-1745.
Nedunchezhiyan, U., Varughese, I., Sun, A. R., et al. (2022). Obesity, inflammation, and immune system in osteoarthritis. Frontiers in immunology, 13, 907750.
Ross, A., Gascon, G. M., Snow, R., et al. (2020). Outcomes of a conservative care program for knee osteoarthritis through translation of research into practice. Musculoskeletal Care, 18(3), 342-351.
Tong, B., Chen, H., Wang, et al. (2024). Clinical prediction models for knee pain in patients with knee osteoarthritis: a systematic review. Skeletal Radiology, 53(6), 1045-1059.
Wei P, Bao R. (2022) Intra-Articular Mesenchymal Stem Cell Injection for Knee Osteoarthritis: Mechanisms and Clinical Evidence. Int J Mol Sci. 24(1):59. doi:10.3390/ijms24010059
Yamamoto, N., Szymski D., Voss, A., et al. (2023) Non-operative management of shoulder osteoarthritis: Current concepts." Journal of ISAKOS 8.5: 289-295.

The Shoulder - Subacromial Impingement

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 10 Jul 2024 03:00:12 GMT

Subacromial impingement is a painful condition that impacts normal shoulder function.

Subacromial impingement is the most common cause of shoulder pain accounting for 44-65% of all shoulder complaints.

Common in persons who play, or have played, repetitive overhead or throwing sports, and manual jobs requiring prolonged overhead positions of the arm, subacromial impingement results from inflammation and degeneration of anatomical structures in the region of the subacromial space, namely the rotator cuff tendons and the subacromial bursa. This irritation results in pain, weakness and loss of active range of motion of the shoulder.

Anatomy 101

The subacromial space is the area between the acromion above and the head of the humerus below. It is occupied by the rotator cuff tendons (as they pass from the shoulder blade (scapula) to the upper arm (humerus)), and the subacromial bursa, a small sack of fluid that acts as a buffer between the tendons and the under surface of the acromion. With repetitive use (eg. tennis, swimming, lifting overhead) the tendons and bursa can become irritated and “impinge” on the acromion causing pain and dysfunction.

Who gets it?

Subacromial impingement is commonly seen in individuals that participate in repetitive overhead movements, for example, volleyballers, swimmers, cricketers, electricians, carpenters, painters and hairdressers. Risk factors include advancing age, a history of heavy lifting, previous shoulder trauma (eg. dislocation or fracture), infection, and smoking history.

Primary Impingement is more common in low load high repetition exposures, for example hairdressers and electricians. Irritation of structures passing under the acromion become irritated and inflamed, reducing the space between the head of the humerus and the acromion and causing impingement.

Secondary Impingement is more common in high load overhead activities such as throwing and racquet sports, swimming and volleyball. Repeated stress at the end of range of movement causes primary shoulder instability. The increased laxity of the joint then results in impingement.

Diagnosing subacromial impingement

Subacromial impingement can be clinically diagnosed by a physiotherapist. A thorough interview will often identify key factors in the past and current history that predispose and contribute to this condition. Patient reported symptoms include pain (for example when raising the arm overhead or lying on the affected side at night), and difficulty with daily tasks such as dressing and hanging washing. Pain is often reported on the outer aspect of the shoulder, though it can refer into the upper arm and shoulder blade.

Signs of subacromial impingement include loss of range of motion of the shoulder joint in particular reaching up and behind the back, weakness of the muscles surrounding the shoulder, and shoulder blade (scapula) dysfunction.

What else could it be?

There are a variety of conditions that present with similar symptoms and signs to subacromial impingement. These include rotator cuff tendonitis, rotator cuff tears , osteoarthritis, frozen shoulder , and labral injuries . Subtle differences in the behaviour of these conditions help us to determine the primary cause of your symptoms and treat it effectively.

Do I need a scan?

A physiotherapist can usually diagnose subacromial impingement without the use of imaging. An in depth subjective and objective assessment which includes a cluster of tests can normally rule in or rule out subacromial impingement. In some instances, xray and/or ultrasound may be recommended to differentially diagnose symptoms and direct a course of treatment.

Treatment

Subacromial impingement is the culmination of a breakdown in shoulder biomechanics resulting in increased load and dysfunction.

The causes of this are complex and multifactorial. For example, shoulder impingement in a swimmer might be due to reduced hip extension, resulting in increased drag in the water and increased load on the shoulder internal rotators to achieve propulsion. In a fast bowler (cricket), it might be caused by altered thoracic (and consequently shoulder) alignment during ball release. Treatment and rehabilitation must be goal-oriented and designed for the individual, and closely monitored and progressed by a physiotherapist.

Research shows that early treatment should focus on reducing pain and inflammation and early therapeutic exercise. Physiotherapist’s can advise about relative rest, avoiding aggravating activities, application of heat or ice, and gentle range of motion activities. Manual and soft tissue therapy may assist with reducing pain and improving shoulder function.

The early phase of rehab is the perfect time to start to address weaknesses and restrictions in other areas that are contributing to symptoms. This might include hip stretches, trunk mobility, or core strengthening exercises, with cross training used to maintain general fitness.

Scapula strengthening is critical and forms the foundation for a successful recovery.

Most cases of subacromial impingement will improve significantly if scapula dysfunction is correctly identified and a therapeutic exercise program prescribed and adhered to. This should be implemented as soon as pain permits and gradually progressed to incorporate rotator cuff and functional shoulder retraining exercises, including appropriate strength, power, endurance, and proprioceptive activities.

Should I get a steroid injection? Or surgery?

In recalcitrant cases corticosteroid injections have been shown to provide short term pain relief and improve function when combined with physiotherapy and exercise. If conservative management and the use of corticosteroid injections have not been effective surgery can be considered.

Research comparing conservative management (including physiotherapy)

and surgical management showed similar outcomes for shoulder function

at both 3, 6 and 12 months after interventions.

How long’s it going to take?

Subacromial impingement is the result of a prolonged period of movement dysfunction and loading. It will take some time to reverse these changes and improve movement patterns. On average we find it takes 3-6 months to reduce pain and improve scapula function. Full resolution of shoulder symptoms and contributing factors can be achieved over a longer period (6-12 months), and future shoulder injury risk minimised with an ongoing exercise routine.

The Take Home

Subacromial impingement is a painful condition that impacts normal shoulder function. Symptoms usually develop over time and are closely related to poor posture, scapula dysfunction and repetitive loading. Subacromial impingement responds well to conservative management, particularly therapeutic exercise. By working closely with a physiotherapist, individuals suffering from subacromial impingement can achieve optimal outcomes and reduce their risk of a recurrence.

Got shoulder pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shoulder pain and let you know whether you have subacromial impingement, injured your labrum, torn your rotator cuff muscles, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Clausen, M. B., Hölmich, P., Rathleff, M., Bandholm, T., Christensen, K. B., Zebis, M. K., & Thorborg, K. (2021). Effectiveness of adding a large dose of shoulder strengthening to current, Nonoperative care for subacromial impingement: a pragmatic, double- blind randomized controlled trial (SExSI trial). The American journal of sports medicine, 49(11), 3040-3049.
Cools, A. M., Witvrouw, E. E., Declercq, G. A., Danneels, L. A., & Cambier, D. C. (2003). Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. The American journal of sports medicine, 31(4), 542-549.
Hosseinimehr, S. H., & Anbarian, M. (2020). The effects of activities related to sports on scapular resting position and scapulohumeral rhythm ratio. Sport Sciences for Health, 16, 713-717.
KÖhler HC, Tischer T, Hacke C, Gutcke A, Schulze C. Outcome of Surgical and Conservative Treatment of Patients with Shoulder Impingement Syndrome - a Prospective Comparative Clinical Study. Acta Chir Orthop Traumatol Cech. 2020;87(5):340-345. English. PMID: 33146602.
Lähdeoja, T., Karjalainen, T., Jokihaara, J., Salamh, P., Kavaja, L., Agarwal, A., ... & Ardern, C. L. (2020). Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis. British journal of sports medicine, 54(11), 665-673.
Nair, T., & Kumar, G. P. (2024). A Guide for Quick Assessment and Management Subacromial Impingement Syndrome.
Tennent, T. D., Beach, W. R., & Meyers, J. F. (2003). A review of the special tests associated with shoulder examination: part II: laxity, instability, and superior labral anterior and posterior (SLAP) lesions. The American Journal of Sports Medicine, 31(2), 301-307.
Watson, L., Balster, S. M., Finch, C., & Dalziel, R. (2005). Measurement of scapula upward rotation: a reliable clinical procedure. British Journal of Sports Medicine, 39(9), 599-603.

Exercise smarter and reach your goals

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 07 Jun 2024 08:54:05 GMT

Goal-driven exercise programs are more effective and engaging.

Every exercise journey starts with a purpose.

It might be to improve your cardiovascular fitness after a health scare, to improve your speed so that you get selected for a team, or to develop a routine that helps reduce weight and control diabetes. Structured in a personalised way, goal-driven exercise programs will be more effective and engaging and reduce your risk of injury along the way.

How do we do this? Using the end goal, we build a fitness base that suits the individual. Features such as strength, endurance, flexibility and skillsets are gradually added, allowing time for the body to adapt and repair. Education also plays a crucial role, teaching people to understand their bodies and listen to the signals they are receiving.

As an example, let’s look at a social runner who wants to run a marathon in 12 months time. Keep in mind this could be any person with any goal.

Goal Setting

The first thing that is required by any client when beginning their exercise journey is goal setting. Once you have a goal in mind you can work around how you go about achieving it and how much time you should set aside to get there. For example, if you have an interest in running, your goal might be to run a marathon in 1 years time.

Once you have decided on the goal, you now need to consider how you will achieve this. Working backwards think about all of the things you must be able to complete before your tackle the marathon, and for each of these smaller tasks, you must think about skills and attributes you need to attain to complete to aid you in achieving these tasks.

When creating your goals, a good acronym to use is the SMART goals. This means the goals are:

S pecific: Goals should be clear and specific, defining exactly what you want to achieve.
M easurable: Goals need to be quantifiable, allowing you to track progress and know when you've achieved them.
A chievable: Goals should be realistic and attainable, considering your resources and constraints.
R elevant: Goals must align with broader objectives and be worthwhile.
T ime-bound: Goals should have a defined timeline, creating a sense of urgency and helping to prioritize tasks.

Together, these principles ensure goals are well-defined, actionable, and motivating. Let's look at these using our runner as an example.

Short-Term Goal (1-2 months)

Specific: Complete a 5km run.
Measurable: Run 5km without stopping.
Achievable: Start with a walk/run program, gradually increasing running intervals.
Relevant: Start with manageable distances and build up gradually to avoid injury.
Time-bound: Complete the 5Km race within 2 months.

Medium-Term Goal (3-6 months)

Specific: Run a half marathon.
Measurable: Run 22km.
Achievable: Follow a training plan that increases weekly km by 10%.
Relevant: Allow time for training and adjust the plan as needed to accommodate progress and setbacks.
Time-bound: Complete the half marathon within 6 months.

Long-Term Goal (9-12 months)

Specific: Complete a full marathon.
Measurable: Run 42km.
Achievable: Maintain a consistent training schedule, gradually increasing long run distances.
Relevant: Allow time for training and adjust the plan as needed to accommodate progress and setbacks.
Time-bound: Finish the marathon by the end of the year, 12 months from the start.

Progressive overload

Progressive overload is a fundamental principle in fitness training, emphasizing gradual increases in stress on the body to enhance performance and strength. For a beginner runner training for a marathon, this could mean slowly increasing your weekly mileage. Starting with shorter runs, you might add 10% more distance each week. If you start with 10 km total in a week, you could aim for 11 km the next week. Additionally, it is important to have training sessions incorporating varied workouts, such as interval training and hill runs, to build endurance and strength. This methodical approach helps the body adapt without causing injury, leading to sustained improvements over time.

Training Different Components of Fitness

Different sports require various components of fitness, including cardiovascular endurance, muscular strength, flexibility, and balance. Training all these components is crucial to achieving optimal performance and preventing injuries. Neglecting one aspect can lead to imbalances, overuse injuries, and decreased overall performance. A well-rounded fitness routine ensures that all muscles, joints and systems are prepared for the sport's demand.

For a beginner runner training for a marathon, it's essential to incorporate not just running, but also strength training, skill training, flexibility exercises and balance training. Strength training such as calf raises and squats build muscle endurance, preventing fatigue and improving running efficiency. Skill training such as skipping with high knees ensures better motor patterning and muscle recruitment. Flexibility exercises, like stretching and yoga, maintain joint health and range of motion, reducing the risk of strains. Balance work, such as stability exercises, enhances coordination and reduces the likelihood of falls and related injuries. By addressing all fitness components, the runner can build a resilient, well-rounded foundation, supporting sustained progress and success in their marathon training.

Listen to your Body

Listening to your body during training is crucial for long-term success and injury prevention. It involves paying attention to signals such as pain, fatigue, and discomfort, and responding appropriately to avoid overtraining and burnout. Ignoring these signs can lead to serious injuries, setbacks, and hindered progress. By tuning in to how your body feels, you can make informed decisions about when to push harder and when to rest. This mindful approach helps in maintaining balance, ensuring that you are challenging yourself without compromising your health. Ultimately, listening to your body promotes sustainable, enjoyable training, allowing for consistent improvements and overall well-being.

The Take Home

With some good planning, working towards fitness goals can be fulfilling and successfully achieved. Allowing time for the body to adapt to the new load, to gradually develop strength, endurance, and flexibility is crucial. Think of it like building a house. Start with the end in mind, build a solid foundation, then gradually add all the special features required to reach the end goal.

Not sure what your body is trying to tell you or need some help with your fitness goals?

Give us a call. We're skilled at structuring goal-oriented exercise programs and recognizing the signs and symptoms of a physically stressed body.

Call now on 08 8945 3799 or book online.

Improving safety and preventing injuries in the workplace

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 16 Apr 2024 06:34:42 GMT

The value of health and safety in the workplace cannot be overstated.

April 28 ^th is World Day for Safety and Health at Work , “an awareness-raising campaign intended to focus international attention on the magnitude of the problem and on how promoting and creating a safety and health culture can help reduce the number of work-related deaths and injuries”.

Workplace injuries are common. According to Safe Work Australia , in 2023 there were 127,800 serious claims. 33% of these injuries were defined as body stress injuries – health problems associated with repetitive or strenuous movement. 36.6% of all serious claims involved joint/ligament and muscle/tendon injuries. With a median time lost to work of 8 weeks and median compensation paid of nearly $16k, workplace health and safety is a big issue.

Why focus on workplace health and safety?

Occupational and workplace health and safety is an essential aspect of modern business operations. Ensuring employees have a safe working environment is not only beneficial for their physical and mental well-being, but it is also crucial for the success of the organization.

There are several key reasons why health and safety in the workplace should be a top priority for employers:

Ensuring the health and safety of employees can help prevent accidents and injuries. Workplace accidents can have a significant impact on both the individual involved and the organization as a whole. They can lead to lost productivity, increased insurance costs, and even legal action against the company. Health and safety policies reduce the risk of accidents and ensure that their employees work in a safe and secure environment.
Promoting health and safety in the workplace can boost employee morale and increase productivity. When employees feel safe at work, they are more likely to be happy and engaged in their work, leading to increased productivity, better quality work, and a more positive work environment. It also builds trust between employers and employees, creating a sense of loyalty and commitment to the organization.
In a competitive job market, prioritizing health and safety in the workplace can help to attract and retain top talent. By demonstrating a commitment to health and safety, companies can attract top talent and retain employees who are invested in the success of the organization.
Prioritizing health and safety in the workplace is essential for meeting legal requirements and regulations. The Australian Government and State and Territory governments have established laws and regulations to ensure that employees have a safe working environment. By prioritizing health and safety, companies can ensure that they are meeting legal requirements and avoid potential legal issues.

The value of health and safety in the workplace cannot be overstated. Prioritizing the well-being of employee’s benefits individuals and has a positive impact on the organization as a whole. By preventing accidents, boosting employee morale and productivity, attracting and retaining top talent, and meeting legal requirements, companies can create a safe and secure work environment that fosters success and growth.

Employers who invest in health and safety are investing in the future of their organization.

Injury Prevention and Risk Management

The aim of any injury intervention strategy should be prevention. Well-designed work can prevent work-related deaths, injuries and illnesses and the potential risk of harm from hazards in a workplace can be eliminated through good work design.

Effective risk management starts with a commitment to health and safety by the business and its workforce and utilises a range of strategies to assess individuals, workplace hazards and job risk in the work environment including:

Pre-employment screening
Ergonomic Risk Assessments
Job Risk Assessments
Manual Handling Training

These simple strategies are low cost, particularly when compared to the cost of a claim, and can effectively identify internal and external risks. For example, a pre-employment screening might identify poor posture (internal risk) that can be corrected with an exercise program effectively reducing the injury risk in a sedentary environment. An ergonomic assessment identifies inappropriate screen height (external risk) that could contribute to a forward head posture and neck pain.

Management of the Injured Worker

Despite our best efforts, accidents happen and injuries occur. When an employee is injured, then the focus should be on ' Good Work ' - early, evidence-informed intervention, with a primary focus on the worker's health and well-being and a timely and effective return to work process.

Early intervention

It is well recognised that delayed treatment of work-related injuries perpetuates a number of negative outcomes that can impact an individual's ability to return to work including prolonged recovery times, increased disability, and reduced functional capacity, all of which can impede an individual's ability to return to work and perform their job duties.

Early intervention encourages the judicious use of health service providers to allow worker's to access the right treatment sooner.

It assists in identifying the mechanism of injury, diagnosis, barriers to recovery and prognosis. Greater understanding of the individual and their injury improves communication, increases comfort and safety, and achieves greater engagement in therapy, leading to better treatment outcomes and reduce drop-out rates. You can read more about the benefits of early intervention for musculoskeletal injuries here .

Workplace Analysis

Understanding the tasks that a client is required to engage in on a daily basis in the workplace is critical to developing an appropriate and meaningful functional rehabilitation program and achieving a successful return to work outcome.

In many instances, simply discussing the routine tasks that a worker performs regularly will provide enough understanding for the clinician to develop an adequate return to work program. Some individuals understand their workplace practices very well and can describe in detail the tasks they undertake, the duration and loads involved, and when breaks are provided to allow rest and recovery. When detail is lacking, HR departments may be able to assist or an onsite workplace analysis performed.

Modified Functional Capacity Evaluation

A Modified Functional Capacity Evaluation (mFCE) is a targeted assessment customised to evaluate an individual's physical abilities, including strength, endurance, range of motion, and functional abilities relevant to their specific job requirements and daily activities. They can:

Identify specific work-related functional deficits.
Assess task specific performance.
Evaluate pain and fatigue.
Help personalize rehabilitation plans.

mFCE’s are an important tool in the evaluation of a person’s capacity to undertake their workplace duties.

They can be useful to assess capacity for upgrades and can easily be performed in the workplace utilising actual tools and equipment. They can also provide insights into options for alternative duties where indicated.

Graded Return to Work

Utilising the information obtained from these assessments, a graded return to work plan (gRTWP) can be established. gRTWP’s are structured plans designed to help an employee who has been absent from work due to illness or injury return to work in a safe and sustainable way. They typically involve a gradual increase in the employee's workload and responsibilities over a period of time, allowing them to gradually build up their capacity and readjust to the demands of their role.

gRTWP’s are developed collaboratively with the worker, employer, and the attending health care team. A typical plan might involve an initial period of reduced hours or modified duties, gradually increasing to full-time hours and normal duties over a period of weeks or months. The plan may also include accommodations such as adjusted work hours, reduced physical demands, or additional support from colleagues or management.

The Take Home

Workplaces should be fun and enjoyable and promote a culture of health and safety. As an accredited organisation Movement For Life Physiotherapy takes these responsibilities seriously. As a health care business, we understand the enormity of workplace injuries and have developed a framework to ensure a valuable contribution to the prevention of workplace injury in the Northern Territory, and robust processes for managing the injured worker when an injury does occur.

As a business are you looking to better manage workplace health and safety and mitigate injury risk?

Have you or a colleague suffered an acute musculoskeletal injury at work?

Give us a call.

We are part of a well-connected local network of physiotherapists, massage therapists, doctors and surgeons

and offer early intervention as part of a comprehensive health care service that is personalised, goal-oriented and outcome focussed.

Call now on 08 8945 3799 or book online.

Sources

Campbell P et al (2022). The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review. https://doi.org/10.3390/ijerph192013416
Dinh MM et al (2016). Understanding drivers of Demand for Emergency Service Trends in Years 2010–2014 in New South Wales: An initial overview of the DESTINY project. doi: 10.1111/1742-6723.12542
Key Work Health and Safety Statistics Australia, 2023. https://data.safeworkaustralia.gov.au/insights/key-whs-stats-2023
Ojha HA et al (2016). Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. https://doi: 10.2519/jospt.2016.6138
Zurynski Y et al (2021). Accessible and affordable healthcare? Views of Australians with and without chronic conditions. https://doi.org/10.1111/imj.15172
https://www.medicalrecruitment.com.au/blog/2018/09/the-top-10-most-common-gp-visits?source=google.com
https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions/contents/summary
https://www.un.org/en/observances/work-safety-day

Reap the rewards of a solid preseason

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 12 Apr 2024 04:19:01 GMT

A good preseason can make a huge difference to our enjoyment and participation in sport.

As another wet season rumbles away to the north and the humidity starts to drop, our thoughts shift to dry season sports – hockey, basketball, netball, cricket, and tennis, to name a few.

A strong preseason can make a big difference not only to your success on the ground or court, but also

the amount of time you spend on it rather than being treated for injuries.

If you’re feeling you might have left your preseason run a little late, don’t despair. The are still benefits to be had from managing the type and frequency of training you undertake over the next few weeks, particularly if it’s in addition to sport-specific training, and every little bit will help you and your team to getting your hands on that next piece of silverware.

What is a preseason?

What does a preseason look like?

The duration of a preseason will vary dependent on the baseline fitness of the individual and demands of the competition. Generally, the preseason period commences about 6-10 weeks out from the commencement of competition. This permits enough time to see the necessary improvements in strength and aerobic capacity for competitive sport, positively impacting performance and reducing injury risk. Ultimately though this is dependent on how well the athlete has look after themselves during the off season. You can read more about what the off-season should look like here.

Preseasons should be progressive, gradually exposing the athlete to higher loads as their body adapts. As the preseason progresses, training focus will likely shift from being generic fitness based to being more sport and skill specific.

Key elements of a successful preseason

Let’s face it. Preseasons can be hard. They require discipline and routine, and the natural flow on from this is motivation. Creating a sustainable routine that aligns with your team and personal goals is fundamental to a successful preseason. Successful preseasons will:

Be objectively driven. What is it you are wanting to achieve before the next season? As a team and/or as an individual, there will be different goals to consider. For example, implementing a new team structure or game plan; increasing base strength and endurance capacity; practicing key sport-specific movement patterns; or enhancing fine and gross motor skills. Any or all of these might be key objectives for the next season.
Keep players in condition during the off season. The last thing you want is to lose all the gains from the previous season. Keeping athletes engaged in fitness and sport should contribute to improvements in physical and mental health, keep the long-term goals of the team in focus, and improve club culture and enjoyment. This is why adhering to a training program even during the off-season is crucial.
Monitor performance progression. This should include monitoring of internal load (an individual’s response to training) and external load (all training imposed on an athlete). Wearables make this so much easier to do, monitoring heart rate metrics, distances, and speeds. Record this data alongside a training diary and you have a great base for monitoring performance and your response to training load.
Meet the specific needs of the individual. We all have variable inherent strengths and weaknesses. Age, genetics, training history, skill level, and injury history all impact the type and style of training required. Effective preseason programs should incorporate a level if individualisation within the wider context of preparing to meet the overarching team objectives for the coming season.

How Preseason training reduces your injury risk

Preparing the body for sport during the preseason has been shown to reduce the number of time-loss injuries across several different sports. Windt et al. (2017) demonstrated a 5% reduction in the percentage of games missed from 10 preseason sessions. How is this achieved? Preseason training utilises a concept called overload, and it is this principal that can improve our physical capacity and help to reduce the risk of injury in-season.

The principal of overload is that load must exceed capacity to improve performance. If this load exposure is slightly greater than load capacity of the structure, then the structure will improve its tolerance to greater load. If the load exposure greatly exceeds the capacity of the tissue, then tissue failure may occur resulting in an injury.

The preseason period is an opportunity to expose the athlete to ever-increasing load that slightly exceeds the capacity of the structure. Provided there is adequate time, the preseason period should enable an athlete to transition from their current physical capacity (the floor) to the required physical capacity for competition (the ceiling). If the duration of the preseason is inadequate, training loads may be progressed too rapidly resulting in an increased risk of injury. Likewise, if the training load is too low, the athlete will be underprepared for the demands in competition.

The pyramid concept

The idea of the preseason is to build a strong foundation, much like that of a pyramid. From this base, the athlete can gradually build on sport specific strength, speed, and coordination. As the preseason progresses and the season proper gets underway, athlete focus can turn to refining their understanding of game plan and structure, further skill development, and maintenance of strength and match fitness. By the end of the season the athlete and the team should be reaching their peak, all off the base of a strong preseason.

The Take Home

We play sport because we love to be active, to spend time with friends and family, to participate and, hopefully, improve skills. The last thing we want is to commit to a season, only to have to sit out periods with an injury. A good preseason can make a huge difference to our enjoyment and participation in sport. Injuries still happen, that’s just a part of sport, but the risk can be mitigated by engaging in a solid preseason and building your sport-specific fitness.

Do you want to improve your on-field performance and reduce your injury risk? Give us a call.

At Movement for Life Physiotherapy, we are as much about injury prevention as we are treatment and management. We love our sport and can work with your coaches to tailor a preseason to your individual needs.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Colby, M. J., Dawson, B., Heasman, J., Rogalski, B., Rosenberg, M., Lester, L., & Peeling, P. (2017). Preseason Workload Volume and High-Risk Periods for Noncontact Injury Across Multiple Australian Football League Seasons. Journal of strength and conditioning research, 31(7), 1821–1829. https://doi.org/10.1519/JSC.0000000000001669
Gabbett, T. J. (2020). How much? How fast? How soon? Three simple concepts for progressing training loads to minimize injury risk and enhance performance. Journal of orthopaedic & sports physical therapy, 50(10), 570-573.
Murray, N. B., Gabbett, T. J., & Townshend, A. D. (2017). Relationship Between Preseason Training Load and In-Season Availability in Elite Australian Football Players. International journal of sports physiology and performance, 12(6), 749–755. https://doi.org/10.1123/ijspp.2015-0806
Windt, J., Gabbett, T. J., Ferris, D., & Khan, K. M. (2017). Training load--injury paradox: is greater preseason participation associated with lower in-season injury risk in elite rugby league players?. British journal of sports medicine, 51(8), 645–650. https://doi.org/10.1136/bjsports-2016-095973

Early Onset Parkinson's Disease

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 03 Apr 2024 08:06:50 GMT

20% of people with Parkinson's disease are under 50 years of age.

Parkinson’s disease (PD) is a complex and progressive disorder characterized by both motor and non-motor symptoms. The prevalence of PD rises sharply with advancing age, with the mean age of onset in the early to mid-60’s. In 3-5% of cases though symptoms start much earlier, between 21 and 50 years of age. This is referred to as Early Onset Parkinson’s Disease (EOPD) and tends to have unique family and societal implications compared to those with late onset PD.

Parkinson’s disease is one of the most common progressive neurodegenerative

diseases in the world, second only to Alzheimer’s disease

Parkinson’s disease presents a significant health burden affecting over 150,000 Australians, 40,000 of them under the age of 50. Every year, another 1,100 people under the age of 65 are diagnosed with PD, with only 16% of those on the NDIS. With no known cure, physiotherapy plays a crucial role in maintaining movement, strength, and function for people with EOPD, and reducing the risk of falls and associated comorbidities.

What causes PD?

The exact cause of PD is still unknown. Genetic and environmental factors are known to be involved however the extent of each remains elusive. In EOPD, genetic factors are believed to play a greater role. What is known is that in PD, cells in an area of the brain known as the substantia nigra begin to die off. The substantia nigra (along with a couple of other areas in the brain) is responsible for the production of dopamine, a neurotransmitter which, when released into the space between neurons, allows nerve impulses to be propagated – essentially for information to move along nerves.

In the same area that dopamine is secreted (the synaptic cleft) there exists a protein called alpha-Synuclein (pronounced sigh-new-clay-in). The role of alpha-Synuclein is to control the release of neurotransmitters like dopamine. In PD, alpha-Synuclei becomes disrupted and tangled, forming what are known as Lewy Bodies. The result of both cell death in the substantia nigra AND the formation of Lewy bodies is suppression of dopamine release which affects movement, memory, mood, sleep, learning, concentration, and other body functions.

Risk factors for PD

Both environmental and genetic factors exist for PD. Genetic factors were first identified about 20 years ago, and this has opened a whole new world of possibilities for understanding, diagnosing, and treating PD, particularly EOPD. Environmental factors such as head injury and exposure to pesticides and heavy metals are identified risk factors.

Current science indicates that in most cases, genetic and environmental factors interact to cause Parkinson’s disease.

Diagnosing PD

Regardless of your age, diagnosis of PD remains largely clinically based on the presenting signs and symptoms. As symptoms appear gradually over time, it can be challenging to accurately diagnose PD in the early stages.

There are a range of symptoms that commonly present in PD. These are frequently grouped in ‘motor’ (such as tremor, rigidity, slowness of movement and difficulty initiating movement) and ‘non-motor’ (such as sleep disorders, pain, gastrointestinal problems, and sensory impairments).

In EOPD, some symptoms such as dystonia (involuntary contraction of muscles) and anxiety and depression are more common and present earlier. There is also a greater presence of Levodopa-induced dyskinesias (uncontrolled, involuntary movements) in EOPD for reasons that are not fully understood (Levodopa is a common medication used to manage Parkinson’s disease. Long term use of Levodopa can result in dyskinesia in all patients with PD, however it is more common in EOPD).

All these symptoms can impact physical and mental health, reduce quality of life, increase financial burden, and have profound social and family effects.

Management and treatment

There is strong evidence to support a multidisciplinary approach to the assessment, treatment, and management of EOPD. This will generally include a neurologist (who makes the primary clinical diagnosis of PD), a GP, Physiotherapist, Occupational Therapist, Speech Therapist and Psychologist.

Fortunately, EOPD tends to have a more benign disease progression, delayed onset of falls and longer survival

Levodopa and Carbidopa are the most common medications for pharmacological management though in EOPD their use may be delayed due to the potential side effects of longer-term use. Levodopa is converted to dopamine in the brain and assists in controlling movement, while Carbidopa prevents the breakdown of levodopa in the blood stream so that more levodopa can enter the brain.

Surgical intervention such as Deep Brain stimulation can be an option when pharmacological treatment is exhausted.

The role of Physiotherapy in EOPD

Physiotherapy plays a crucial role in in the management of EOPD, maintaining functional capacity across the lifespan, slowing symptom progression, reducing falls risk as symptoms progress, and improving self-confidence.

Recent studies have shown that people with PD spend 75% of waking hours sedentary. Persons with PD are 30% less likely to be active compared to healthy individuals, with only 18% undertaking regular low level physical activity and only 6% engaging in regular moderate to vigorous physical activity. If your lifestyle is already sedentary, undertaking small amounts of light to moderate intensity exercises such as walking, gardening, and stretching is a good start.

Early engagement with a physiotherapist will improve your understanding and management of PD, and assist in

developing key exercise and lifestyle habits to improve your health and wellbeing even with PD.

A wholistic approach will look beyond the PD diagnosis and take in the bigger picture. Regular physiotherapy and exercise progression and modification will help improve bone and joint health, look after muscle strains and joint pains, and keep your heart and lungs working at their best.

Exercise type and volume

Therapeutic exercise must be prescribed and individualised and incorporate strengthening (compound) exercises, aerobic exercise, and balance strategies. The goal should be to engage in 30-60mins of targeted exercise every day of varying type and intensity. Where possible programs should include some moderate and high intensity exercise, dependent on individual capacity and risk assessment.

Gym programs, walking, cycling and swimming can all be undertaken by people with PD, depending on your symptoms. Hydrotherapy, yoga and clinical pilates classes are appropriate and effective at different stages throughout the lifespan and have been shown to improve strength, balance and functional movement.

You can learn more about the role of physiotherapy-led therapeutic exercise for PD here .

Special Considerations for EOPD

People with EOPD are at a different stage of life and tend to have different family and societal responsibilities to those diagnosed later in life. Many patients will still have a job, be raising or wanting to raise a family, have active social lives, and be eager to travel and explore.

It is important that a multi-disciplinary approach considers the life stage and goals of the individual. Treatment and management must give consideration to employment status, finances, parenting and family responsibilities, and relationships. More information on these can be found at www. shakeitup.org.au .

The Take Home

Early Onset Parkinson’s disease is a challenging diagnosis that requires skilled, multi-disciplinary management. As a progressive neurological disease that affects dopamine production in the brain, EOPD will result in a range of motor and nonmotor symptoms. Physiotherapy and physiotherapy-directed exercise has been shown to improve health related quality of life for people with EOPD. By working closely with a physiotherapist across the lifespan, individuals with EOPD can delay symptom progression, improve functional capacity, mitigate falls risk and improve their independence, self-confidence and health related quality of life.

Do you have early onset Parkinson's disease and want to effectively manage your symptoms? Give us a call.

At Movement for Life Physiotherapy, we understand Parkinson's disease and can safely assess your symptoms and tolerance to physical activity in a controlled environment. With a clear understanding of your functional capacity and a tailored management plan, we'll help keep you moving and doing all the things you love in life.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Biddiscombe, K. J., Ong, B., Kalinowski, P., & Pike, K. E. (2020). Physical activity and cognition in young‐onset Parkinson’s disease. Acta Neurologica Scandinavica, 142(2), 151-160.
Camerucci, E., Stang, C. D., Hajeb, M., Turcano, P., Mullan, A. F., Martin, P., ... & Savica, R. (2021). Early-onset parkinsonism and early-onset Parkinson’s disease: A population-based study (2010-2015). Journal of Parkinson's disease, 11(3), 1197-1207.
Ferguson, L. W., Rajput, A. H., & Rajput, A. (2016). Early-onset vs. Late-onset Parkinson’s disease: A Clinical-pathological Study. Canadian journal of neurological sciences, 43(1), 113-119.
Mehanna, R., Smilowska, K., Fleisher, J., Post, B., Hatano, T., Pimentel Piemonte, M. E., ... & Salari, M. (2022). Age cutoff for early‐onset Parkinson's disease: recommendations from the International Parkinson and Movement Disorder Society task force on early onset Parkinson's disease. Movement Disorders Clinical Practice, 9(7), 869-878.
Post, B., Van Den Heuvel, L., Van Prooije, T., Van Ruissen, X., Van De Warrenburg, B., & Nonnekes, J. (2020). Young onset Parkinson’s disease: a modern and tailored approach. Journal of Parkinson's disease, 10(s1), S29-S36.
Wickremaratchi, M. M., Ben‐Shlomo, Y., & Morris, H. R. (2009). The effect of onset age on the clinical features of Parkinson’s disease. European journal of neurology, 16(4), 450-456.

Balance, mobility and exercise for Parkinson's disease

Wed, 03 Apr 2024 03:55:51 GMT

Reducing your falls risk is crucial with Parkinson's disease.

Parkinson’s disease (PD) is a complex and progressive neurological disease caused by a reduction in dopamine production, a neurotransmitter produced in the brain, and, as a result, altered nerve firing patterns. PD is characterized by both motor and non-motor symptoms and presents a significant health burden affecting over 150,000 Australians at a cost of about $10 billion annually to our healthcare system.

Parkinson’s disease is one of the most common progressive neurodegenerative

diseases in the world, second only to Alzheimer’s disease

Every year, about 1,100 people under the age of 65 are diagnosed with PD, with only 16% of those on the NDIS. With no known cure, physiotherapy plays a crucial role in maintaining balance, mobility, strength, and function for people with PD, and reducing the risk of falls and associated injuries.

The focus of this blog is on how physiotherapy can reduce complications for people who have PD. If you want to learn more about the causes and risk factors for PD, check out this article - Physiotherapy for Parkinson's disease .

Features of Parkinson’s Disease

Dopamine is an important chemical messenger in the brain that plays a critical role in many body functions. As a neurotransmitter, dopamine is involved in movement, memory, attention, behaviour, cognition, sleep, arousal, mood, and learning. Dopamine also plays a role as a ‘reward centre’, making you feel happy, motivated, alert, and focused.

A lack of dopamine in the brain can adversely affect these normal processes, impacting many regions

of the brain and nervous system and, subsequently, human function.

The reduction in dopamine producing cells manifests in both motor and non-motor symptoms including altered mood and cognition, resting tremor, muscle rigidity, slowness of movement and freezing of movement. Ultimately, PD affects many aspects of daily life, including social, work and family, and has a profound impact on the individual’s independence and mental health.

Risk factors for persons with PD

Parkinson’s disease is more prevalent in persons aged 65 years or older and so people with PD are more likely to have comorbidities (or other disease processes) present – things like diabetes, heart disease, osteoarthritis, and cancer. PD is also related to an increased risk of developing other health conditions, in particular coronary artery disease, respiratory disease, stroke, and depression.

PD impacts movement. Key features of PD include tremor, rigidity, slowness and freezing of movement. People with PD will naturally reduce their level of activity and social interactions, often resulting in further physical deconditioning, functional impairments, anxiety and depression.

The risk of falls in this cohort is high. Studies have shown that between 45% and 68% of people

with PD will fall each year, most falling recurrently.

The increase in fall rates massively increases the risk of fractures in this population. Persons with PD sustain hip fractures at a rate four times that of age-matched individuals without PD. PD patients who sustain fractures often require hospitalization which is known to exacerbate Parkinsonian symptoms, impact ability to self-care, and is a key driver of the economic burden of PD.

Finally, recent studies have shown that people with PD spend 75% of waking hours sedentary. Persons with PD are 30% less likely to be active compared to healthy individuals, with only 18% undertaking regular low level physical activity and only 6% engaging in regular moderate to vigorous physical activity.

Where to start

Undertaking regular exercise is essential to maintain longer term independence, slow symptom progression and reduce the risk of other health concerns following a diagnosis of PD. Simple lifestyle changes can make a big difference. If your lifestyle is already sedentary, undertaking small amounts of light to moderate intensity exercises such as walking, gardening, and stretching is a good start.

It is important that exercise programs are safe and effective. PD, particularly in the presence of other diseases,

requires careful planning and monitoring.

It is highly recommended to consult with a physiotherapist prior to commencing a new exercise program. A physiotherapist can record important baseline measures, prescribe therapeutic exercise that is relevant to your symptoms, monitor the program for effectiveness and modify where and when appropriate.

Balance, stretch and strengthen

We can’t cure Parkinson's disease, but with a holistic approach utilizing a multi-disciplinary team of qualified health professionals, symptoms can be managed, and independence maintained for a longer period.

Motor disturbances seen in Parkinson's disease contribute to a decline in balance, mobility, and strength,

and ultimately impact activities of daily living (ADL’s).

This puts an individual at a much higher risk of falling when compared to the typical population. Targeted exercise can address this.

Research has shown that an exercise plan that challenges balance and addresses muscle strength and flexibility improves independence, reduces the rate of falls and improves the quality of life in individuals living with Parkinsons disease. Resistance training programs are very effective for this population. According to the Parkinsons Foundation, completing resistance training 3 times per week can improve Parkinsonian symptoms, make dopamine use more effective, and potentially slow PD progression. Resistance exercise also helps maintain bone health and ward off osteoporosis thereby reducing fracture risk if a person does fall.

Stretching, both passive and active, can help to reduce rigidity of muscles and stiffness in joints. Physiotherapy can assist in measuring joint range of motion and assessing baseline muscle tightness. Soft tissue therapy, massage therapy and a regular stretching routine can then be employed to target tightness and delay joint stiffness.

For people with PD, balance issues can have a profound impact on social and emotional well-being. Reduced balance increases anxiety and fear, which in turn can impact participation in ADL’s, therapeutic exercise, and social activities. Incorporating safe and effective balance exercises into your daily routine improves confidence, movement, strength, and independence.

Exercise Options

Having an exercise routine is important and if this can be incorporated into some social time then even better. A daily walk with a family member or friend, a regular falls and balance class, and some home-based strengthening exercises are good habits to follow.

Gym programs, walking, cycling, and swimming can all be undertaken by people with PD, depending on your symptoms. Yoga and clinical pilates classes are appropriate and effective, as are falls and balance classes. Hydrotherapy is a good option in early-stage PD, especially when unable to perform land-based exercises, for example due to arthritis. The heated water can reduce pain, and provides buoyancy, hydrostatic pressure, and resistance to effectively reduce stress on the joints, assist with blood flow and strengthen muscles through movement.

The Take Home

Parkinson’s disease is a common, progressive neurological disease for which exercise plays a crucial role. Physiotherapy-directed exercise that addresses strength, balance and flexibility concerns has been shown to improve health related quality of life for people with PD. By working closely with a physiotherapist, individuals with Parkinson’s disease can delay symptom progression, improve functional capacity, mitigate falls risk, and improve their independence and self-confidence.

Do you have Parkinson's disease and want to effectively manage your symptoms? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Chua, S. K. K., Saffari, S. E., Lee, S. J. Y., & Tan, E. K. (2022). Association between Parkinson’s disease and coronary artery disease: A systematic review and meta-analysis. Journal of Parkinson's Disease, 12(6), 1737-1748.
Hommel, A. L., Krijthe, J. H., Darweesh, S., & Bloem, B. R. (2022). The association of comorbidity with Parkinson's disease-related hospitalizations. Parkinsonism & related disorders, 104, 123-128.
Kouli, A., Torsney, K. M., & Kuan, W.-L. (2018). Parkinson’s Disease: Etiology, Neuropathology, and Pathogenesis. In T. B. Stoker & J. C. Greenland (Eds.), Parkinson’s Disease: Pathogenesis and Clinical Aspects. Codon Publications. http://www.ncbi.nlm.nih.gov/books/NBK536722/
Latif, S., Jahangeer, M., Razia, D., et al. (2021). Dopamine in Parkinson's disease. Clinica chimica acta, 522, 114-126. https://doi.org/10.1016/j.cca.2021.08.009
Matinolli, M., Korpelainen, J. T., Korpelainen, R., Sotaniemi, K. A., Matinolli, V. M., & Myllylä, V. V. (2009). Mobility and balance in Parkinson’s disease: a population‐based study. European Journal of Neurology, 16(1), 105-111.
Parkinson’s Disease and Strength Training: Benefits | Parkinson’s Foundation. (2016, December 7). https://www.parkinson.org/blog/tips/strength-training
Pelicioni, P. H. S., Menant, J. C., Latt, M. D., & Lord, S. R. (2019). Falls in Parkinson’s Disease Subtypes: Risk Factors, Locations and Circumstances. International Journal of Environmental Research and Public Health, 16(12), 2216. https://doi.org/10.3390/ijerph16122216
Richter, D., Bartig, D., Krogias, C., & Tönges, L. (2020). risk comorbidities of COVID-19 in Parkinson’s disease patients in Germany. Neurological Research and Practice, 2(1), 22. https://doi.org/10.1186/s42466-020-00069-x

Physiotherapy for Parkinson's Disease

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 26 Mar 2024 04:45:41 GMT

Keeping active is critical to slow symptom progression with Parkinson's disease.

Parkinson’s disease (PD) is a complex and progressive disorder characterized by both motor and non-motor symptoms. It is caused by a reduction in dopamine production, a neurotransmitter produced in the brain, and, as a result, altered nerve firing patterns.

Parkinson’s disease is one of the most common progressive neurodegenerative

diseases in the world, second only to Alzheimer’s disease

Parkinson’s disease presents a significant health burden affecting over 150,000 Australians at a cost of about $10 billion annually to our healthcare system. Every year, about 1,100 people under the age of 65 are diagnosed with PD, with only 16% of those on the NDIS. With no known cure, physiotherapy plays a crucial role in maintaining movement, strength, and function for people with PD, and reducing the risk of falls and associated injuries.

What causes PD?

The exact cause of PD is still unknown. What we do know is that for reasons not fully understood, cells in an area of the brain known as the substantia nigra begin to die off. The substantia nigra (along with a couple of other areas in the brain) is responsible for the production of dopamine , a neurotransmitter which, when released into the space between neurons, allows nerve impulses to be propagated – essentially for information to move along nerves.

Risk factors for PD

Both environmental and genetic factors exist for PD. Genetic factors were first identified about 20 years ago, and this has opened a whole new world of possibilities for understanding, diagnosing, and treating PD. Environmental factors such as head injury and exposure to pesticides and heavy metals are identified risk factors. Current science indicates that in most cases, genetic and environmental factors interact to cause Parkinson’s disease.

The single biggest risk factor for PD remains advancing age, with men have a somewhat higher risk than women.

While PD is most common in older age groups (60 plus years) there has been an increase in the diagnosis of early onset Parkinson’s disease (those aged under 50), possibly due to better understanding, awareness, and health care access.

Diagnosing PD

Diagnosis of PD is largely clinically based on the presenting signs and symptoms. As symptoms appear gradually over time, it is challenging to accurately diagnose PD in the early stages. Fortunately, over the past 8 years, there have been important developments regarding diagnosis, mainly through medical observation and improved assessment of both motor and nonmotor clinical signs.

The motor (movement) symptoms include:

Tremor
Rigidity (stiffness)
Bradykinesia (slowness of movement)
Difficulty initiating movement
Postural instability which can result in reduced balance and increased falls risk.

The nonmotor symptoms include:

Sleep disorders
Pain
Mental health issues such as anxiety and depression
Gastro-intestinal symptoms
Sensory impairments such as loss of hearing or smell.
Cognitive and behavioural changes including dementia

Any or all of these symptoms can reduce quality of life, increase financial burden and have profound social and family effects.

Is a scan required?

Imaging is not specifically required for the diagnosis of PD, however scans such as MRI, CT and PET scans may be used to rule out other conditions.

Management and treatment

There is strong evidence to support a multidisciplinary approach to the assessment, treatment, and management of PD. This will generally include a neurologist (who makes the primary clinical diagnosis of PD), a GP, Physiotherapist, Occupational Therapist, Speech Therapist and Psychologist.

Levodopa and Carbidopa are the most common medications for pharmacological management. Levodopa is converted to dopamine in the brain and assists in controlling movement, while Carbidopa prevents the breakdown of levodopa in the blood stream so that more levodopa can enter the brain.

Surgical intervention such as Deep Brain stimulation can be an option when pharmacological treatment is exhausted.

The role of Physiotherapy in PD

Physiotherapy plays a crucial role in in the management of PD, maintaining functional capacity, slowing symptom progression, reducing falls risk, and improving self-confidence.

Physiotherapy care should be individualised and based on a thorough assessment of your symptoms, goals, and risks.

Physiotherapist directed resistance exercise can improve cardiovascular and brain health, reduce incidence of osteoporosis, build strength and reduce falls risk, and have broader positive effects on physical and mental health, including sleep habits. Manual therapy can delay joint stiffness and the slowing of movement and, combined with exercise, improve balance and reduce falls risk. Movement and cueing strategies can assist with problems related to initiating movement, improve mobility, and reduce sedentary hours.

Exercise type and volume

Gym programs, walking, cycling and swimming can all be undertaken by people with PD, depending on your symptoms.

Simple lifestyle changes can make a big difference following a diagnosis of PD. Group yoga and clinical pilates classes are appropriate and effective, as are falls and balance classes. If your lifestyle is already sedentary, undertaking small amounts of light to moderate intensity exercises such as walking, gardening, and stretching is a good start. Hydrotherapy can be effective in early-stage PD, especially when unable to perform land-based exercises. The heated water can reduce pain, and provides buoyancy, hydrostatic pressure, and resistance to effectively reduce stress on the joints, assist with blood flow and strengthen muscles through movement. Learn more about hydrotherapy here .

The Take Home

Parkinson’s disease is a common, progressive neurological disease that affects dopamine production in the brain, causing a range of motor and nonmotor symptoms. A multi-disciplinary approach that incorporates physiotherapy and physiotherapy-directed exercise has been shown to improve health related quality of life for people with PD. By working closely with a physiotherapist, individuals with Parkinson’s Disease can delay symptom progression, improve functional capacity, mitigate falls risk and improve their independence and self-confidence.

Do you have Parkinson's disease and want to effectively manage your symptoms? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Bloem, B.R., Okun, M.S., & Klein, C. (2021). Parkinson’s Disease. The Lancet, 397 (10291), 2284-2303, DOI: https://doi.org/10.1016/S0140-6736(21)00218-X
Bouça-Machado, R., et al. (2020). Physical Activity, Exercise, and Physiotherapy in Parkinson’s Disease: Defining the Concepts. Movement Disorders. Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts (wiley.com)
Cristini, J., et al. (2021). The effects of exercise on sleep quality in persons with Parkinson's disease: A systematic review with meta-analysis. Sleep Medicine Reviews , 55, 101384. https://doi.org/10.1016/j.smrv.2020.101384
Eriksson, B-M., Arne, M., & Ahlgren, C. (2013). Keep moving to retain the healthy self: the meaning of physical exercise in individuals with Parkinson’s disease, Disability and Rehabilitation, 35:26, 2237-2244, DOI: 10.3109/09638288.2013.775357
Greenland, J.C., & Baker, R. A. (2018). The Differential Diagnosis of Parkinson’s Disease. National Library of medicine. DOI: 10.15586/codonpublications.parkinsonsdisease.2018.ch6
Latif, S., et al. (2021). Dopamine in Parkinson’s Disease. Clinical Chimica Acta, 522, 114-126. https://doi.org/10.1016/j.cca.2021.08.009
Mei, J., Desrosiers, C., & Frasnelli, J. (2021). Machine learning for the Diagnosis of Parkinson’s Disease: A review of literature. Frontiers in aging Neuroscience, 13. https://doi.org/10.3389/fnagi.2021.633752
Shake it up Australia Foundation. https://shakeitup.org.au/ . Accessed 26/03/2024.
Vazquez-Velez, G.E., & Zoghbi, H.Y. (2021). Parkinson’s Disease Genetics and Pathophysiology. Annual review of Neuroscience, 44, 87-108.
World Health Organization. (2023). Parkinson’s Disease. Parkinson disease (who.int)

Physiotherapy-led Exercise for Endometriosis

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 05 Mar 2024 08:56:48 GMT

The right type of exercise can reduce pain and improve your quality of life with endometriosis.

Endometriosis is a common, chronic disease affecting women of child-bearing age in which cells similar to the endometrial tissue that line the uterus grow in other locations in the body.

Affecting approximately 1 million Australian women at some point in their lifetime, endometriosis costs Australia about

$9.7 billion annually in direct healthcare costs and lost productivity.

Endometriosis represents a significant health issue that demands our attention and requires greater exploration and publication of healthcare options, including physiotherapy and therapeutic exercise.

Endometriosis primarily affects the reproductive organs and the pelvic cavity, however it can also affect the bowel and bladder, even the lungs and brain. Endometrial cells infiltrating these areas cause inflammation and the formation of scar tissue and adhesions. Endometriotic lesions have both a blood and nerve supply and it is the latter that causes a main symptom of endometriosis - chronic pelvic pain.

The cause of endometriosis remains unknown. Those people who have a close relative (eg. mother or sister) with endometriosis are 7-10 times more likely to develop the condition. The immune system’s role in breaking down endometrial cells that have entered the pelvis may also be implicated.

Current Management

Current medical management of endometriosis is focused on pharmacological and surgical approaches. This includes the use of pain-relief medicines, hormone therapy, and surgical procedures. When available, Women’s & Pelvic Health Physiotherapists are often involved, utilizing a range of skills including kinesiotherapy, manual therapy, and pelvic floor exercises. This combination therapy approach can be effective when disease is caught early.

Unfortunately, the average time to diagnosis for endometriosis is 6.5 years from onset of symptoms.

As a result, large numbers of women live without a clear diagnosis for many years and develop a broad range of variable symptoms. While treatable, this delay makes eventual management more challenging and prolonged. Even after conventional treatment 20-40% of women report insufficient reduction in pain and reduced health-related quality of life.

A role for exercise in managing endometriosis

Exercise therapy has been shown to be an important component of the management of chronic pelvic pain and part of a holistic approach to managing endometriosis. How does exercise achieve this? When we exercise, our body releases endorphins. These hormones improve our mood, reduce stress levels and, importantly, act as a natural pain killer.

Exercise also has an inhibitory effect on the hormone prostaglandin. During the menstrual cycle, as the endometrial lining starts to break down, prostaglandins are released. During this phase of the menstrual cycle, prostaglandins play a couple of important roles:

Prostaglandins are an inflammatory mediator and contribute to the normal bodily function of fighting infection and ridding the body of unwanted tissue.
Prostaglandins cause smooth muscle to contract. Thus, it causes the uterus and blood vessels to contract. If the prostaglandin level is higher, the degree of contraction will be greater.

Women with endometriosis have been found to have higher levels of circulating prostaglandins, possibly contributing to a raised state of ‘inflammation’ and many of the symptoms they experience. During menstruation, prostaglandin levels will be further raised, contributing to symptoms of dysmenorrhea - cramp and pain during the menstrual cycle.

So, exercise makes sense – reduce the level of pain-causing prostaglandins back towards normal, and increase levels of our natural pain killers, the endorphins. But what if exercising itself is painful?

Therapeutic Exercise

Patients with endometriosis commonly present with chronic intermittent or persistent pelvic pain, a factor which can limit participation in traditional land-based exercise (eg. Walking, jogging, cycling and weights programs). On assessment, physiotherapists will commonly identify a weak pelvic floor, often in combination with weak gluteal, abdominal, and lower back muscles – essentially a weak ‘core’.

So how do we get our endorphins flowing if pain is limiting our participation in exercise?

Where persistent pain is limiting land-based activity and core strength is reduced, combination exercise therapy of clinical pilates and hydrotherapy can be hugely beneficial.

Clinical Pilates

Clinical pilates is a form of low-impact exercise delivered by qualified health care professionals with the purpose of addressing disease symptoms and rehabilitation. It differs from general pilates in that it is individualized and prescribed. You can read more about the differences here .

Clinical pilates focuses on the control of body positions and movement. By incorporating breath control, clinical pilates calms the nervous system, reducing stress and relieving symptoms of anxiety and depression. Exercises are either floor-based or involve the use of specialized equipment which provides resistance via springs. The traditional principles of centering, concentration, control, precision, flow, and breathing are incorporated into programs designed to improve muscle strength, control, and flexibility. It is an effective form of exercise for addressing general pelvic floor weakness and for improving core stability and functional strength.

Studies have shown that Clinical pilates programs reduce prostaglandin levels during menstruation and increase levels of endorphins in patients with endometriosis. This results in the reduction of both the frequency and severity of menstrual cramps, a reduction in reported pain and anxiety, and improvements in health-related quality of life questionnaires.

Hydrotherapy

Hydrotherapy is the second part of the equation for people with persistent pelvic pain that find land-based exercising difficult. The purpose of hydrotherapy is to create an environment where low impact strength and aerobic exercise can be undertaken, that is condition specific and physically restorative. Performed in a heated pool, hydrotherapy uses warmth, buoyancy, and hydrostatic pressure to create a weightless supportive environment for the individual to exercise in. The temperature of the water is a key component, encouraging muscle relaxation and cardiac output, and reducing pain.

Hydrotherapy is a great mode of physical activity that helps to relieve symptoms associated with endometriosis while still offering an opportunity to gain the benefits of exercise. The heat of the water helps muscles surrounding the pelvis and lower back to relax, while the buoyancy of the water permits a variety of strengthening and aerobic exercises to be undertaken that may be difficult to complete on land.

The take home

Endometriosis is a challenging disease to manage, with a large spectrum of symptoms. While some people will require specialist intervention, for many, education, advice, and a supportive management plan that incorporates suitable exercise will make a significant difference to day-to-day symptoms. Hydrotherapy and clinical pilates are cheap, accessible, non-invasive, and effective options that can reduce pain associated with endometriosis and contribute to improvements in health-related quality of life.

Do you have endometriosis and want a non-invasive, exercise-based option to help manage your pain?

Give us a call.

At Movement for Life Physiotherapy, we understand pelvic pain. We are part of an extensive network of health professionals in Darwin and the Top End. Our caring, empathetic, professional clinicians individualise treatment approaches based on your goals, help reduce chronic pain, and improve health-related quality of life.

Through movement and education, we'll help get you back to the things you love sooner.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Chowdhury, R. S., Islam, M. D., Akter, et al. (2021). Therapeutic aspects of hydrotherapy: a review. Bangladesh Journal of Medicine, 32(2), 138-141.
Jean Hailes Foundation. https://www.jeanhailes.org.au/health-a-z/endometriosis , accessed 5 ^th March 2024.
Juhn, S. K., Jung, M. K., Hoffman, M. D., Drew, B. R., Preciado, D. A., Sausen, N. J., Jung, T. T., Kim, B. H., Park, S. Y., Lin, J., Ondrey, F. G., Mains, D. R., & Huang, T. (2008). The role of inflammatory mediators in the pathogenesis of otitis media and sequelae. Clinical and experimental otorhinolaryngology, 1(3), 117–138. https://doi.org/10.3342/ceo.2008.1.3.117
Lausen, A., Marsland, L., Head, S., Jackson, J., & Lausen, B. (2018). Modified Pilates as an adjunct to standard physiotherapy care for urinary incontinence: A mixed methods pilot for a randomised controlled trial. BMC Women’s Health, 18(1), 16. https://doi.org/10.1186/s12905-017-0503-y
Song, B. H., & Kim, J. (2023). Effects of Pilates on Pain, Physical Function, Sleep Quality, and Psychological Factors in Young Women with Dysmenorrhea: A Preliminary Randomized Controlled Study. Healthcare, 11(14), 2076. https://doi.org/10.3390/healthcare11142076
Ricciotti, E., & FitzGerald, G. A. (2011). Prostaglandins and inflammation. Arteriosclerosis, thrombosis, and vascular biology, 31(5), 986–1000. https://doi.org/10.1161/ATVBAHA.110.207449
Sprouse-Blum, A. S., Smith, G., Sugai, D., & Parsa, F. D. (2010). Understanding endorphins and their importance in pain management. Hawaii medical journal, 69(3), 70–71
Tennfjord, M. K., Gabrielsen, R., & Tellum, T. (2021). Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC women's health, 21(1), 1-10.
Wells, C., Kolt, G. S., & Bialocerkowski, A. (2012). Defining Pilates exercise: A systematic review. Complementary Therapies in Medicine, 20(4), 253–262. https://doi.org/10.1016/j.ctim.2012.02.005
Wójcik, M., Szczepaniak, R., & Placek, K. (2022). Physiotherapy management in endometriosis. International Journal of Environmental Research and Public Health, 19(23), 16148.

Reducing Pain for Patients with Endometriosis

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 04 Mar 2024 06:28:47 GMT

The value of physiotherapy in managing endometriosis is underrated.

Endometriosis is a common, chronic disease affecting women of child-bearing age in which cells similar to the endometrial tissue that lines the uterus grow in other locations in the body. Commonly found in the pelvis and reproductive organs, endometriosis can impact the bowel, bladder and has been found as far away as the lungs and the brain. Endometriosis results in inflammation, formation of scar tissue and adhesions in the pelvic and abdominal region, chronic pelvic pain and, in some instances, infertility.

Facts and Stats

Endometriosis is a prevalent condition that affects almost 1 million Australians at some point within their lives. The condition, which is usually first apparent at the onset of menstruation, can take up to 6.5 years to be diagnosed.

A lack of research scrutiny and public awareness means management remains largely biomedical

(surgical and pharmacological) with insufficient outcomes on the primary symptoms of pain and reduced quality of life.

Endometriosis is reported to cost Australia $2.5 billion dollars annually in direct healthcare costs and a further $7.2 billion annually in lost productivity.

Fact: Marilyn Munroe suffered with endometriosis and underwent several surgeries to manage the condition. The chronic pain associated with endometriosis often meant she was late to set and at times, heavily medicated, and unfairly deemed “difficult” to work with (Source: Hard Quiz (2024), https://www.youtube.com/watch?v=v_6svtN7-oU ).

The Australian Longitudinal Study on Women’s Health , last updated in December 2023, is a great resource for information on endometriosis. This study has shown that for women born between 1973 and 1978, 14% have been diagnosed with endometriosis by age 44-49. More recent data has shown that by age 31, 9.2% of women in a younger cohort (born 1989 – 1995) had endometriosis compared with 6.9% in the 1973-1978 cohort, which may reflect increased awareness of endometriosis among the public and health professionals, leading to increased diagnosis among women born more recently.

Risk factors for endometriosis are broad including prematurity and low birth weight, painful menarche and cyclic pain that increases during menstruation, autoimmune diseases, and obstetric surgery. The biggest risk factor though is a family history, particularly amongst first degree relatives, with conveys a 6-7 fold increase in risk of endometriosis.

Signs and Symptoms

The most common symptom associated with endometriosis is pain, often severe, in the lower abdomen (pelvis). Endometriotic lesions are frequently found to have both a blood supply and a nerve supply and it is the latter that contributes to the broad range of pain symptoms experienced. These can include:

Dysmenorrhea - painful menstruation;
Dyspareunia - painful sexual intercourse;
Dyschezia - painful defecation;
Dysuria - painful urination and, in general;
Chronic pelvic pain - pain perceived to originate in the pelvis lasting for longer than 6 months.

These symptoms can result in reduced participation in physical activity and higher prevalence of chronic fatigue. They can also impact sleep quality, relationships, mental health, and overall quality of life.

Management of Endometriosis

Currently guidelines recommend pharmaceutical (pain relief medication and oral contraceptive pill) and surgical management as the first line of treatment for endometriosis. However, this approach is often insufficient for satisfactory pain control, particularly in severe cases. Research shows that 20-40% of people with the disease still experience symptoms following this line of treatment.

Physiotherapy in its various forms can be an alternative and an excellent complement to surgical and pharmacological treatment of endometriosis. Physiotherapy (and importantly, Specialist Women's Health Physiotherapy) has been shown to reduce inflammation, alleviate pain and thus significantly improving women’s quality of life.

Physiotherapy approaches such as kinesiotherapy, manual therapy, exercise therapy and hydrotherapy can improve pain related symptoms, function, exercise tolerance and sleep quality, and overall quality of life for people living with endometriosis.

Physiotherapists are great educators. They have an advanced understanding of anatomy, WHY you get the symptoms you do, and how your body responds and adapts to pain; they can provide advice on relaxation and movement strategies and education on good bladder and bowel control habits; and they can provide strategies to optimise pelvic floor function and assist in the pre and post endometriosis surgery phases.

Why Physio-led exercise is so important

Few health professionals have the combined knowledge of anatomy, physiology, pathology,

pain science, and exercise therapy that Physiotherapists do.

Physiotherapists work as part of a multi-disciplinary team - with your doctor, surgeon, psychologist and other health care professionals. This allows physiotherapists to personalise and adapt treatment and exercise prescription to the individual dependent on the history, behaviour and current presenting pathology.

Why exercise? Regular physical activity has been shown to have positive effects when it comes to managing chronic pain and psychological symptoms (such as low mood and anxiety) that are commonly associated with endometriosis. The potential benefits of exercise for people living with endometriosis include:

Reduced inflammation
Downregulating or calming the nervous system, particularly the pain pathways
Improved cardiovascular fitness, strength, and energy levels
Improved sleep habits and quality of sleep
Enhanced emotional wellbeing and engagement
Regulation of body weight

What type of exercise could I be doing with endometriosis?

Any exercise program should be personalised, relevant and engaging for the individual.

Factors such as previous exercise history, other health conditions, age, and personal goals will influence the type,

frequency, and intensity of exercise. In a nutshell, one size DOES NOT fit all.

Gentle aerobic based activities such as walking, jogging and body weight resistance programs are great places to start before progressing to more moderate and high intensity exercise. If pain is limiting participation in these activities, then we recommend getting started with combination exercise therapy of hydrotherapy and clinical pilates .

Incorporating a progressive strengthening program focusing on the low back, abdominals and pelvis can also be beneficial. Again, clinical pilates is great for this. Most exercise programs will progressively work towards five 20-30mins sessions of moderate intensity exercise and two strength sessions weekly, but this is dependent on many factors.

Keep in mind if you have had surgery you need to be medically cleared before returning to physical activity and progressions may be a little slower.

As always, we strongly recommend engaging with your physiotherapist to design, monitor and progress an exercise program.

To find out more about the benefits of Clinical Pilates and Hydrotherapy for Endometriosis, click here .

The take home

Endometriosis is a common, painful condition that benefits hugely from physiotherapy intervention across the child-bearing years. Surgical and pharmacological intervention (ie. usual medical care) is often insufficient to satisfactorily control pain in endometriosis patients. The addition of physiotherapy-led education, manual therapy, therapeutic exercise and strengthening programs has been demonstrated to improve the symptoms of endometriosis, improve health related quality of life and will ultimately reduce the direct and indirect costs of this disease on the healthcare system.

Do you have endometriosis and want a non-invasive, exercise-based option to manage your pain?

Give us a call.

Through movement and education, we'll help get you back to the things you love sooner.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Australian Institute of Health and Welfare. (2023). Endometriosis. Retrieved from https://www.aihw.gov.au/reports/chronic-disease/endometriosis-in-australia
Bull, F. C., Al-Ansari, S. S., Biddle, S., Borodulin, K., Buman, M. P., Cardon, G., ... & Willumsen, J. F. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine, 54(24), 1451-1462.
Endometriosis Australia. https://endometriosisaustralia.org/ Accessed 4 ^th March 2024.
Gete, D. G., Doust, J., Mortlock, S., Montgomery, G., & Mishra, G. D. (2023). Associations between endometriosis and common symptoms: findings from the Australian Longitudinal Study on Women’s Health. American Journal of Obstetrics and Gynecology, 229(5), 536-e1.
International working group of AAGL, ESGE, ESHRE and WES, Tomassetti, C., Johnson, N. P., Petrozza, J., Abrao, M. S., Einarsson, J. I., ... & De Wilde, R. L. (2021). An international terminology for endometriosis, 2021. Human Reproduction Open, 2021(4), hoab029.
Rowlands, I. J., Abbott, J. A., Montgomery, G. W., Hockey, R., Rogers, P., & Mishra, G. D. (2021). Prevalence and incidence of endometriosis in Australian women: a data linkage cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 128(4), 657-665.
Tennfjord, M. K., Gabrielsen, R., & Tellum, T. (2021). Effect of physical activity and exercise on endometriosis-associated symptoms: a systematic review. BMC women's health, 21(1), 1-10.
Wójcik, M., Szczepaniak, R., & Placek, K. (2022). Physiotherapy management in endometriosis. International Journal of Environmental Research and Public Health, 19(23), 16148.

Massage Therapy for Hypertension

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 22 Feb 2024 02:36:08 GMT

How massage therapy can help lower your blood pressure.

Hypertension (high blood pressure) occurs when the pressure in the blood vessels is too high. It is a common condition and a significant public health issue due to the potential for serious health consequences if untreated. Often asymptomatic, the only way to diagnose hypertension is by having your blood pressure checked by a health care professional.

In developed countries, one in three adults has hypertension.

The World Health Organization (WHO) defines hypertension as pressure greater than 140/90mmHg and prehypertension as between 120-139/80-89mmHg. Repeat readings indicative of prehypertension are a predicator for hypertension and guide health care professionals to recommend early intervention.

Treatment and Management of Hypertension

Pre-hypertension and hypertension are largely diseases of lifestyle. Factors such as high salt intake, smoking, excessive alcohol intake, stress, and lack of physical activity all contribute to the development of hypertension. Other factors that contribute to the development of high blood pressure include obesity, kidney disease, diabetes, cancer, and cancer treatment.

When assessing blood pressure, two pressures are obtained – systolic, which is the pressure in your arteries when the heart contracts, and diastolic, which is the pressure in your arteries when your heart rests between beats. Blood pressure is always reported as systolic/diastolic in milliliters of mercury (mmHg). Normal resting blood pressure is 120/80mmHg.

Treatment and management of pre-hypertension is primarily non-pharmacological, including education and

advice regarding modification of lifestyle, and massage therapy.

In addition to the above, for hypertension, pharmacotherapy is indicated. Medications such as Angiotensin Converting Enzyme (ACE) Inhibitors, Angiotensin Receptor Blockers (ARB), and Calcium Channel Blockers (CCB) are commonly used to lower and maintain a safe blood pressure range, particularly in recalcitrant cases where lifestyle modification has been ineffective or where comorbidities contribute to unacceptable health risks.

Massage as Therapy for Pre-Hypertension and Hypertension

While lifestyle modification and exercise are mainstay treatments for high blood pressure, various lower quality studies have highlighted the impact of massage therapy among individuals with high blood pressure, particularly prehypertension.

The findings of this research underscored massage therapy as a popular intervention for managing

prehypertension – it’s non-invasive, non-medicative, accessible and economical and with almost

no serious side effects. In many respects it is enjoyable.

Studies by Givi (2013) and Mohebbi et al., (2014) found significant improvements in both systolic and diastolic blood pressures with 30 minutes of massage therapy three times a week. Moreover, these positive effects were still observed 72 hours later (Givi, 2013).

The effects of massage therapy on diagnosed hypertension are less conclusive, with only small and transient reductions observed. Further studies in this area are required. This should not take away from the many other benefits of massage therapy in this patient cohort such as reductions in muscle tightness and stress, and improved mood and sense of well-being.

The effect of Massage Therapy on blood pressure

Massage therapy contributes to a reduction in blood pressure via several effects. Massage therapy stimulates and modulates proprioception, reduces activity in the sympathetic nervous system and increases parasympathetic activity. This helps relax the body, reduce levels of cortisol (the stress hormone), and increase levels of endorphins, serotonin, and dopamine in the blood stream. Blood vessels dilate, reducing blood flow resistance and subsequently blood pressure. With the reduction in stress and anxiety, and a more relaxed state, heart rate also reduces.

What type of massage is best?

Various types of massage therapy offer benefits for addressing prehypertension and hypertension. Techniques that promote activation of the endocrine system, and therefore our feel-good hormones, are likely to be more effective on blood pressure.

Studies have found a positive effect on prehypertension and heart rate from Swedish massage,

suggesting its efficacy in managing these conditions.

The duration and frequency of massage therapy sessions will vary greatly depending on individual circumstances. 30-minute sessions one to two times weekly are indicated in the research. Typically, a session lasting half an hour, focusing on areas such as the skull, face, neck, shoulders, and chest, has been seen to be effective at reducing prehypertension. However, session type, duration and frequency can be tailored according to the individual's symptoms, physical condition, and pre-existing health conditions.

The Take Home

Hypertension is a pervasive health issue in the Western world that results in irreversible damage to arteries throughout the body including the heart, brain, liver, and kidneys. In all cases, lifestyle changes are essential, and in many instances, pharmacotherapy is indicated. Massage therapy, particularly Swedish massage, presents as an effective adjunct treatment for the management of prehypertension and may benefit those with hypertension. It is non-invasive, economical, accessible, and safe, and may produce short to medium-term improvements in both systolic and diastolic pressures as well as a reduction in resting heart rate.

Are you prehypertensive or have a diagnosis of hypertension? Give us a call.

At Movement for Life Physiotherapy, we have a fully qualified remedial massage therapist who can help with hypertension and works with out clinical team to achieve outstanding results.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Anderson C., Arnolda L, Cowley D., et al (2016) Guidelines for the diagnosis and management of hypertension in adults. National Heart Foundation of Australia.
Gholami-Motlagh, F., Jouzi, M., & Soleymani, B. (2016). Comparing the effects of two Swedish massage techniques on the vital signs and anxiety of healthy women. Iranian journal of nursing and midwifery research, 21(4), 402.
Givi, M. (2013). Durability of effect of massage therapy on blood pressure. International Journal of preventive medicine, 4(5), 511.
Jones, N. R., McCormack, T., Constanti, M., & McManus, R. J. (2020). Diagnosis and management of hypertension in adults: NICE guideline update 2019. British Journal of General Practice, 70(691), 90-91.
Mohebbi Z, Moghadasi M, Homayouni K, Nikou MH. The effect of back massage on blood pressure in the patients with primary hypertension in 2012-2013: a randomized clinical trial.Int J Community Based Nurs Midwifery. 2014;2(4):251-258.
Vijayakumar, V., Boopalan, D., Ravi, P., et al. (2023). Effect of massage on blood pressure in patients with hypertension: A meta-analysis. Journal of Bodywork and Movement Therapies.

General Health - Getting active to help manage weight

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 20 Feb 2024 03:15:19 GMT

Getting active is key to managing weight, and your physio can help.

March 4th marks World Obesity Day 2024, with the global theme "Let's talk about Obesity and..." .

Effective, multi-disciplinary health care intervention for the management of obesity continues to be constrained by damaging misconceptions and poor understanding of the complex nature of obesity as a disease. World Obesity Day is an opportunity to emphasise the need for collaboration and collective action to help improve the health of people living with obesity and reduce their risks of further disease.

For more information on World Obesity Day 2024, please visit The Obesity Collective .

The rate of overweight and obese individuals worldwide has grown significantly in the past 50 years, with roughly two thirds of Australian adults currently falling into either of these categories. Worldwide, at least 2.8 million people die each year from being overweight or obese.

Increased body weight and obesity are multifactorial, complex disease processes that occur when an individual has

excessive amounts of fat storage in their body that presents a risk to health.

It is associated with chronic systemic inflammation, due to the immune system activation in the adipose tissue that promotes an increased release of pro-inflammatory cytokines. As the name suggests, these cytokines promote inflammation in the body.

Low-grade inflammation is a characteristic of various chronic diseases such as type II diabetes, cardiovascular disease, and metabolic syndrome. Individuals who are obese have a higher risk of various types of cancer (colorectal, post-menopausal breast, uterine, oesophageal, kidney and pancreatic cancer) and are at a significantly higher risk of having a cardiovascular event (heart attack or stroke). The increased load through the joints may also contribute to higher rates of osteoarthritis and musculoskeletal dysfunction/injuries.

What is a ‘Body Mass Index’?

According to the World Health Organisation (WHO), Body Mass Index (BMI) is a simple index of weight-for-height, commonly used to classify overweight and obesity in adults. It is calculated by dividing a person's weight in kilograms by the square of their height in meters (kg/m ² ).

For example, a person who is 1.86m tall and weighs 95kg will have a BMI of 95/1.86 ² = 27.45kg/m ² .

For adults, WHO defines overweight as a BMI of greater than or equal to 25, and obesity as a BMI of greater than or equal to 30.

How can I become healthier?

Improving our health often requires making lifestyle changes that can be challenging, even uncomfortable. The first step to making these changes is ensuring you have the right people to support your goals. There is no quick fix to improving your health and losing weight. In fact, you are better off taking a ‘slow and steady’ approach, as research shows this is produces more sustainable lifestyle changes resulting in improved fitness, mood, and quality of life.

If your goal is to lose some weight, take a holistic approach and commit to making small, achievable, sustainable changes to your lifestyle. These changes can focus on:

Exercise: Getting your heart rate up and sweating a little for just 20mins a day will increase energy expenditure, and improve muscle strength, balance, and cardiovascular fitness.
Diet: Having the right nutrition levels and reducing your intake of processed sugary foods is a good start. Grab a little extra fruit and veg at the market, experiment with salads at meal times and find some healthy snacks to get you through the day.
Sleep: Deprivation of sleep is associated with growth hormone deficiency and elevated cortisol levels, which are both linked to weight gain and obesity. How can you change your night-time habits to reduce screen time and sleep better?
Stress levels: Cortisol, the hormone that is released when we are stressed, is linked with weight gain and obesity. We also tend to eat more (and more ‘sugar high’ foods) when we are stressed. Light exercise such as Tai Chi, Yoga and meditation can help reduce stress, while having some healthy snacks around can help for those high stress moments.
Sedentary levels: Sedentary habits decrease the amount of energy expenditure for an individual. Getting up and moving more frequently will increase your energy expenditure, and your muscles and joints will love it too.

Each of the changes listed above all play a crucial role improving your overall health, managing the weight, and reducing risk of other illnesses.

Why do we love exercise so much? Click here to see why.

Don’t go it alone.

Breaking old habits can be tough. As already mentioned, having the right support network around you is crucial to succeeding with your own personal health goals. Friends and family can be great. They can also make it more challenging too, particularly if you have a busy lifestyle and are time poor, or their own beliefs and experiences with weight loss clash with yours!

Remember, weight gain occurs for a multitude of reasons – systemic disease, medications, injuries, diet, even where we live.

So, make sure you get professional advice from trusted health care practitioners.

There are many health professionals you can consult depending on which aspects of life you would like assistance in, such as:

Dietitian: Help with nutritional needs and graduated dietary changes
Physiotherapist: To assist with pre-existing injuries and pain that might be impacting exercise tolerance, and to prescribe, monitor and progress tailored exercise plans to get you fit and healthy
Psychologist: Help to manage the stress in your life, provide emotional support in your quest and overcome mental health barriers that might be impacting your weight loss goals
Doctor: Monitor your general health, treat, and manage other medical conditions, and manage prescription medication.

What exercises should I do?

There are no hard and fast rules when it comes to exercise. Everyone has different interests and goals, meaning the exercise plan should be tailored to each person. In general, it is best to complete some type of exercise every day than nothing at all. There is strong evidence to suggest that a combination of lower-moderate intensity aerobic training, as well as resistance training is effective at reducing body fat stores, building muscle volume and strength, and improving cardiovascular health.

Engagement and enjoyment are key, so these programs are flexible and tailored to the person to be

done at home, in the gym, at the park or in a class setting.

When completing aerobic training, it is helpful to monitor your heart rate to understand what level of intensity you are working at. A simple way to work this out is to calculate your maximum heart rate, which is 220 minus your age, then monitor your heart rate and turn it into a percentage of your maximum heart rate. Aim to work in a heart rate zone of 60-80% of your maximum heart rate to ensure you’re in the right heart rate zone to burn fat and improve aerobic fitness.

For example, a 50-year-old person should aim for a target heart rate during exercise of:

(220 – 50) x 60% to (220 – 50) x 80%

= (170 x 0.6) to (170 x 0.8)

= 102 to 136 bpm

The Take Home

Increased body weight and obesity are complex, multi-factorial disease processes with no quick fix. Undertaking regular, targeted exercise will help you to stay fit and healthy and will contribute to a reduction in body weight and related health risks. A holistic approach will incorporate, at various times, your GP, a dietician, and psychologist to address the many factors that contribute to weight gain and obesity. Physical activity is just one component of a multi-disciplinary approach to weight loss and is an easy place to get started. Walk with your dog, dust off the bike and go for a ride, or just get out and play with the kids or grandchildren - any exercise you can do will be beneficial to you!

Are you overweight or obese and want to improve your health? Give us a call.

At Movement for Life Physiotherapy, we understand physical and exercise therapy for weight loss. We can safely assess your tolerance to physical activity in a controlled environment. With a clear understanding of your physical capacity and a tailored management plan, we'll help get you back to the things you love sooner.

For more information and appointments, please contact us on 08 8945 3799 or book online.

Sources

Reyes-Romero, M. A., Rodríguez-Hernández, H., Rodríguez-Ramírez, G., & Simental-Mendía, L. E. (2013). Obesity and Inflammation: Epidemiology, Risk Factors, and Markers of Inflammation. International Journal of Endocrinology, 2013, e678159. https://doi.org/10.1155/2013/678159
Bennie, J. A., Blair, S. N., Brellenthin, A. G., Lee, D., & Sui, X. (2021). Resistance exercise, alone and in combination with aerobic exercise, and obesity in Dallas, Texas, US: A prospective cohort study. PLOS Medicine, 18(6), e1003687. https://doi.org/10.1371/journal.pmed.1003687
Alam, K., Al-Hanawi, M. K., Biddle, S. J. H., Gow, J., Hashmi, R., Keramat, S. A. (2021). Trends in the prevalence of adult overweight and obesity in Australia, and its association with geographic remoteness. Scientific Reports, 11(1), 11320. https://doi.org/10.1038/s41598-021-90750-1
World Health Organisation (2021). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight . Accessed 20/02/2024.

Heart Health - Hydrotherapy for Chronic Heart Failure

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 15 Feb 2024 08:56:47 GMT

Hydrotherapy is a great exercise medium if you have chronic heart failure.

Chronic heart failure (CHF), also known as congestive heart failure, is a clinical syndrome characterized by the inability of the heart to pump blood adequately to meet the body's metabolic demands. A prevalent condition within the Australian community, over 110,000 people live with CHF. Fortunately, research over the past 30 years has significantly improved the treatment and management of this condition, resulting in improved outcomes and quality of life.

Exercise and physical activity for people with chronic heart failure

Individuals diagnosed with CHF are routinely advised to engage in physical activity by their health care team.

Exercise based rehabilitation programs have consistently shown improvements in

patient reported symptoms, exercise tolerance and quality of life.

Traditional land-based exercise approaches often include stationary cycling, walking, and resistance exercises. While effective, these may not be suitable for all patients, particularly those that are elderly or frail, or who have limiting co-morbidities such as chronic pain, osteoarthritis, or balance issues. This can lead to reduced participation in physical activity, greater deconditioning, and increased risk of mortality.

Hydrotherapy – an effective alternative to land-based exercise

Hydrotherapy has been used for the management for chronic heart failure (CHF) for decades and is an attractive and effective alternative to conventional land-based exercise and has been shown to have significant benefits for individuals living with CHF. The low-gravity, temperature-controlled environment promotes muscle relaxation, reduces muscle and joint stiffness, and improves the dilation of the peripheral blood vessels.

The hydrostatic effect of immersion in warm water is associated with increased blood flow back to the heart,

thereby reducing blood pressure and improving cardiac output.

It also improves kidney and nerve activity and reduces blood plasma levels of certain hormones such as epinephrine, renin, and aldosterone, which further helps regulate blood pressure and thoracic blood volume. Pretty impressive.

The warm water environment provides a great medium for performing both aerobic and strengthening exercises and thereby reversing de-conditioning and improving functional capacity. Movement against the resistance of the water increases the heart rate and respiratory rate, improving aerobic capacity. By utilising different speeds of movement and equipment to modify the resistance load, muscle can be strengthened, toned, and gently stretched, improving land-based function and balance.

Hydrotherapy’s your friend, with benefits.

For those people who have co-morbidities such as osteoarthritis, back pain, or chronic pain, hydrotherapy will likely have a positive impact on these conditions as well. Resistance exercises aimed to improve cardiovascular fitness will also strengthening weak, deconditioned muscles in affected areas. The warm-water environment releases endorphins that will improve mood. In addition to stretching stiff joints and strengthening muscles, hydrotherapy promotes relaxation and a sense of well-being that in turn can have a positive impact on mental health and motivation.

Outcomes of Hydrotherapy for people with CHF

The research on hydrotherapy for people with CHF consistently reports improvements in quality of life and functional capacity, particularly activities of daily living. When undertaken regularly (30-60mins, 3 times a week) and consistently, hydrotherapy can contribute to a reduction in blood pressure and heart rate, and improvements in heart function. This positive effect of hydrotherapy can be further augmented through the addition of a land-based exercise program if able.

Importantly, hydrotherapy is not a replacement for pharmacological and medical management.

A multi-disciplinary team approach to the management of CHF is critical to achieving

sustainable long term positive outcomes.

Accessing Hydrotherapy with CHF

Hydrotherapy sessions are delivered in a variety of ways to cater for the different needs of individual patients. One on one sessions are required in the introductory phase to ascertain exercise tolerance and develop a suitable program. Once an individual is safe and understands their program, they may attend group sessions that are supervised by a physiotherapist.

Those individuals with mild CHF may be suitable to attend open pool sessions where there is no physiotherapist supervision. Alternatively, if their exercise tolerance permits, attending aqua aerobics classes may be suitable. We strongly recommend that you discuss these options as they arise with your treating medical practitioner.

The Take Home

For patients with chronic heart failure, hydrotherapy is well tolerated and associated with significant improvement in exercise capacity, functional capacity, and quality of life. Hydrotherapy is a useful alternative for many elderly patients with CHF who are limited in their ability to participate in land-based activities, simultaneously improving heart function as well as other disorders that impede normal activities of daily living.

Got a heart complaint or want to improve your heart health? Give us a call.

Movement For Life Physiotherapy operates a purpose-built hydrotherapy pool at their Coconut Grove clinic. This facility is maintained at a constant 33-35oC, has both ramp and chair hoist access, and is perfect for undertaking regular exercise for conditions such as chronic heart failure. Classes and individual appointments are available daily Monday to Friday.

For more information and pricing, please contact us on 08 8945 3799.

Sources

Adsett, J. A., Mudge, A. M., Morris, N., Kuys, S., & Paratz, J. D. (2015). Aquatic exercise training and stable heart failure: A systematic review and meta-analysis. International journal of cardiology, 186, 22-28.
Caminiti, G., Volterrani, M., Marazzi, G., Cerrito, A., Massaro, R., Sposato, B., ... & Rosano, G. (2011). Hydrotherapy added to endurance training versus endurance training alone in elderly patients with chronic heart failure: a randomized pilot study. International journal of cardiology, 148(2), 199-203.
Cider, Å., Sveälv, B. G., Täng, M. S., Schaufelberger, M., & Andersson, B. (2006). Immersion in warm water induces improvement in cardiac function in patients with chronic heart failure. European journal of heart failure, 8(3), 308-313.
Graetz, B., Sullivan, M., Robertson, T., & Reeve, J. (2015). Do hydrotherapy exercise programmes improve exercise tolerance and quality of life in patients with chronic heart failure? A systematic review.
Michalsen, A., Lüdtke, R., Bühring, M., Spahn, G., Langhorst, J., & Dobos, G. J. (2003). Thermal hydrotherapy improves quality of life and hemodynamic function in patients with chronic heart failure. American heart journal, 146(4), 728-733.
Municinó, A., Nicolino, A., Milanese, M., Gronda, E., Andreuzzi, B., Oliva, F., & Chiarella, F. (2006). Hydrotherapy in advanced heart failure: the cardio-HKT pilot study. Monaldi Archives for Chest Disease, 66(4).
Grüner Sveälv, B., Cider, Å., Täng, M. S., Angwald, E., Kardassis, D., & Andersson, B. (2009). Benefit of warm water immersion on biventricular function in patients with chronic heart failure. Cardiovascular ultrasound, 7, 1-8.

Heart Health - Physical Activity and Exercise for Chronic Heart Failure

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 15 Feb 2024 00:01:40 GMT

Getting active is critical if you have chronic heart failure.

The treatment and management of chronic heart failure (CHF) has changed dramatically over the last 30 years leading to significantly improved outcomes and quality of life. A prevalent condition within the Australian community, over 110,000 people live with chronic heart failure, and exercise programs play a crucial role in their treatment, management, and quality of life.

What is Chronic Heart Failure?

Chronic heart failure (CHF), also known as congestive heart failure, is a clinical syndrome characterized by the inability of the heart to pump blood adequately to meet the body's metabolic demands. This results in symptoms such as shortness of breath (dyspnoea), fatigue, reduced exercise tolerance, and fluid retention.

Some of the signs of CHF include an enlarged heart (due to the heart trying to work harder and beat faster), persistent cough or wheeze, rapid or irregular heart rate and abnormal blood pressure, the latter contributing to other signs such as swollen ankles and pulmonary crackles on auscultation. The body tries to make other physiological adaptations too, like retaining water and salt and narrowing the blood vessels in its attempt to keep blood pressure up and circulation normal. However, these compensatory measures are not sustainable processes. Left untreated, symptoms will gradually progress with increasing risk of heart attack, stroke, and organ failure.

What causes chronic heart failure?

The causes of CHF are varied and complex. Broadly speaking, CHF results from either:

1. Factors affecting the pumping ability of the heart (systolic function), and;

2. Factors affecting the hearts filling ability (dystolic function)

Factors contributing to the development of CHF can be intrinsic, such as the genetics we inherit, and extrinsic,

such as lifestyle choices like diet and smoking. Other disease processes can also contribute to the development

of CHF, such as infections and diabetes.

Lifestyle factors that increase the chance of developing CHF are considered modifiable as we can generally choose how much we are exposed to them. Things like smoking, excessive alcohol consumption, poor dietary choices, and lack of physical exercise are modifiable risk factors for CHF that can contribute to the build-up of plaque on arteries and increase blood pressure.

Is exercise and physical activity safe for people with chronic heart failure?

Yes! Individuals diagnosed with CHF are routinely advised to engage in physical activity by their health care team. However, physical activity remains low in this population group. Many people with a heart condition fear that exercising may be harmful, but evidence shows that those people who are more physically active and exercise are generally healthier than those who don’t. However, it is important to get advice from a health care professional before getting into exercise to gradually improve your fitness.

What type of physical activity should I be completing?

Physical activity for people with CHF should be tailored to the individual’s goals and objectives and should be engaging for the person. It is important to explore different exercise strategies with your physiotherapist to find a type and style that you are interested in, fits your lifestyle, and can safely enjoy.

There is strong evidence that aerobic and resistance training, tai chi, and hydrotherapy

are suitable means of exercise for people with CHF.

These programs can be done at home, using personal equipment such as a treadmill or stationary bike and dumbbells, as part of a group such as aqua aerobics, through a local gym, or swimming at your local pool.

Personal trainers can be beneficial to keep you motivated and committed, provided you have consulted with your health team first and have had your exercise program prescribed by a physiotherapist.

Remember that exercise and physiotherapy is just one part of the management strategy for CHF. Your heart health team comprising your doctors, nurse practitioner, pharmacist, dietician, and psychologist all play an important role in your heart health. Physical activity should be prescribed, managed, and progressed by your physiotherapist as part of this multi-disciplinary team.

How much physical activity should I be completing?

The volume and intensity of physical activity that an individual with CHF will be able to undertake will be dependent on the stage of disease, physical symptoms, mental health, and age of the person. This is why consulting with a physiotherapist who is part of a multi-disciplinary team is so important.

Baseline exercise tolerance must be assessed and determined in a controlled environment.

Monitoring heart rate and other physical symptoms while exercising on a treadmill or stationary bike, or while doing other simple functional activities, and then assessing recovery rates is a valuable way of safely setting a baseline for physical activity. Some individuals will only manage 5-10mins of light physical activity twice a day, while others will tolerate much more.

This data can then be used to tailor an exercise program to the individual and safely progressed accordingly.

The Take Home

Chronic Heart Failure is a relatively common condition that affects thousands of Australians. While outcomes and quality of life have improved dramatically over the past 30 years, the uptake of physical activity by people with CHF remains poor. Physiotherapists have an extensive knowledge of cardiac health and exercise prescription. As a valued health professional they can assist in engaging people with CHF with physical activity and have a positive impact on the health outcomes of individuals and thus the broader community.

Got a heart complaint or want to improve your heart health? Give us a call.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Amirova, A., Fteropoulli, T., Williams, P., & Haddad, M. (2021). Efficacy of interventions to increase physical activity for people with heart failure: a meta-analysis. Open heart, 8(1), e001687. https://doi.org/10.1136/openhrt-2021-001687
Andersson, B., Cider, Å., Schaufelberger, M., & Sunnerhagen, K. S. (2003). Hydrotherapy—A new approach to improve function in the older patient with chronic heart failure. European Journal of Heart Failure, 5(4), 527–535. https://doi.org/10.1016/S1388-9842(03)00048-5
Care, A. G. D. of H. and A. (2021). Australian Government Department of Health and Aged Care; Australian Government Department of Health and Aged Care. https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-adults-18-to-64-years
Chun, K. H., & Kang, S. M. (2021). Cardiac rehabilitation in heart failure. International Journal of Heart Failure, 3(1), 1.
McDonagh, T. A., Metra, M., Adamo, et al (2022). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 24(1), 4-131.
Patti, A., Merlo, L., Ambrosetti, M., & Sarto, P. (2021). Exercise-based cardiac rehabilitation programs in heart failure patients. Heart Failure Clinics, 17(2), 263-271.
Taylor, R. S., Dalal, H. M., & McDonagh, S. T. (2022). The role of cardiac rehabilitation in improving cardiovascular outcomes. Nature Reviews Cardiology, 19(3), 180-194.

The Knee - Patella Tendinopathy

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 10 Jan 2024 23:56:11 GMT

Patella tendinopathy is a complex condition that requires skilled management.

Patella tendinopathy is a common overuse injury characterised by pain in the front of the knee. The condition was originally labelled "jumpers’ knee" due to its high prevalence in jumping-based sports, however it is commonly associated with other sports that involve frequent change of direction, acceleration, and deceleration.

Anatomy 101

The patella tendon is a strong, fibrous band of tissue located just below the kneecap (patella) and connects the patella to the shin bone. The role of the tendon is to extend (or straighten) the knee and is essentially a continuation of the quadriceps muscle at the front of the thigh. When the quadriceps muscles contact, they generate a force that is transmitted to the patella tendon via the patella, effectively straightening the knee.

Who gets it?

Patella tendinopathy is most common in young male athletes (15-30 years old) who participate in sports such as volleyball, basketball, AFL, soccer, and athletic jumping events. All these activities place load on the patella tendon as it works to accelerate knee extension (eg. kicking a ball) or decelerate knee bending (eg. when landing from a jump). The most significant risk factor for patella tendinopathy is the training load of an athlete. The more hours a week the tendon is required to work to complete activities like jumping and changing direction, the more susceptible the athlete is to developing patella tendinopathy.

Diagnosing Patella Tendinopathy

The presenting history is often the key to identifying patella tendinopathy. The type, volume, and frequency of load exposure provides the physiotherapist with insight to the cause of knee pain, symptom progression, and recovery time.

The most common symptom reported with patella tendinopathy is pain in the front of the knee just below the kneecap (inferior border of the patella). In the earlier phases of the condition, this pain most often arises following activity, while in the later phases pain develops while undertaking activity and may persist for periods following activity cessation. Common positions that aggravate knee pain in more advanced cases include sitting for extended periods (such as car or plane travel) and descending stairs.

Patella tendinopathy is diagnosed through taking a detailed history of the patient and physical assessment. The therapist will get the athlete to complete a variety of functional tests that load up the tendon which may start with squats before progressing to jumping, hopping, and sport-specific movement. If the pain in front of the knee is reproduced when completing these movements, a clinical diagnosis can be made.

Patella tendinopathy can be mistaken for other conditions characterised by pain in front of the knee such as Osgood Schlatter’s disease, meniscal injuries, patella femoral pain syndrome, and Hoffa's fat pad irritation, so it is important to get a full assessment and differential diagnosis by a qualified health professional.

Do I need a scan?

In most cases scans (Xray, MRI, Ultrasound) are not required. It is important to appreciate that patella tendinopathy may be present in some individuals and not cause any symptoms. For this reason, diagnosis is not reliant on medical imaging. In recalcitrant cases, imaging may be helpful to include or exclude potential alternate diagnoses.

Treatment

Treatment for patella tendinopathy is dependent on many different factors including the age of the person, duration of symptoms, load exposure, and activity type. No two presentations will be the same, so seek guidance from a physiotherapist to ensure you understand the condition and rehabilitation that is specific to you.

Research shows that the best form of treatment for patella tendinopathy is relative load reduction and exercise. Load reduction refers to reducing training and/or game time to limit the load through the patella tendon. This will look different for every person - it may include reducing the amount of jumping or sprinting within a training session, reducing the number of high-load days each week, or total hours of training per week.

Importantly, in most cases, complete rest should be avoided. Instead, high load activities should be swapped for low energy storage activities such as swimming or cycling. This is critical for the tendon to maintain integrity.

Exercise is critical in the rehabilitation of patella tendinopathy and can be implemented at the commencement of the program. Isometric exercises have been shown to help reduce pain and maintain tendon integrity while minimising muscle deconditioning.

Once pain has reduced to a manageable level, heavy, slow resistance training can be introduced. This must be guided by your physiotherapist to ensure the correct exercises are undertaken and limiting symptoms do not return.

With adequate symptom management and exercise progression, "energy storage exercises" (exercises that load the tendon) can be introduced – activities like jumping, hopping, and running. This stage will be very specific to the athlete's chosen sport and is the precursor to a gradual return to sport. Full return to sport is dependent on pain free completion of the energy storage phase that replicates the demand of the individual's chosen sport.

Ice, non-steroidal anti-inflammatories, and soft tissue therapy can help reduce pain in the initial stages of patella tendinopathy, however, if the athlete finds no clinical benefit there is no rationale to continue. Corticosteroid injections could be of benefit in reducing symptoms in patella tendinopathy but only temporarily. Research has shown that physiotherapy in combination with injection will give the best result when compared to injection alone.

Surgery is rarely indicated and should be avoided in most cases. Studies show that there is no significant benefit of surgery over physiotherapy-guided rehabilitation and no surgery (conservative management).

How long is it going to take?

The amount of time it takes to recover from patella tendinopathy and return to sport is dependent on duration and severity of symptoms, type of sport, athlete performance level, time of intervention, and adherence to rehabilitation plan. Research shows return to sport post patella tendinopathy can take between 20 and 90 days depending on the severity of the condition. The earlier the athlete is assessed, treated, and prescribed an individualised rehabilitation program, the more likely they are to have a quicker return to sport and reduce the likelihood of re-injury.

The Take Home

Patella tendinopathy is a painful, irritating condition of the knee that responds well to conservative management. Physiotherapy plays a vital role in addressing pain, inflammation, and mechanical stress while promoting tissue healing and restoring function. By working closely with a physiotherapist, individuals suffering from patella tendinopathy can achieve great outcomes and reduce their risk of re-injury.

Got knee pain and want to know the cause? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your knee pain and let you know whether you have patella tendinopathy, Osgood Schlatter disease, patellofemoral pain syndrome, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Bloom OJ & Mackler L (2004). What is the best treatment for Osgood-Schlatter disease?
Clark SC, Jones MW, Choudhury RR, & Smith E (1995). Bilateral patellar tendon rupture secondary to repeated local steroid injections. Emergency Medicine Journal. 12(4):300-1.
Corbi F, Matas S, Álvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, & López-Laval I (2022) Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare. 2022; 10(6):1011. https://doi.org/10.3390/healthcare10061011
Gholve PA, Scher DM, Khakharia S, Widmann RF, & Green DW (2007). Osgood Schlatter syndrome. Current Opinion in Pediatrics, 19(1), 44-50.
Kaya DO, & Toprak U (2017). Osgood-Schlatter disease: diagnosis and treatment. EFORT Open Reviews, 2(11), 447-453.
Neuhaus C, Appenzeller-Herzog C, & Faude O (2021). A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Physical Therapy in Sport, 49, 178-187.
Pihlajamäki H, & Visuri T (1999). Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men: surgical technique. The Journal of Bone & Joint Surgery, 81(10), 1426-1432.
Rathleff MS, Winiarski L, Krommes K, et al. (2020). Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2020;8(4). doi: 10.1177/2325967120911106
Vaishya R, Azizi AT, & Agarwal AK (2016). Osgood-Schlatter disease: A review of literature. Journal of Clinical Orthopaedics and Trauma, 7(4), 244-248.
Weiner DS, & Macnab I (1971). The "traction" apophysitis. The American Journal of Sports Medicine, 3(3), 152-154.

Returning to Play post Concussion

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 12 Dec 2023 08:00:04 GMT

Concussion is a traumatic brain injury. So how do you safely return to play?

Concussion is a traumatic brain injury.

Commonly the result of direct or indirect head or facial trauma, concussion negatively impacts a person’s personal life and career. While most people make a full recovery from concussion, some people struggle. Meanwhile, the idea that repeat concussive episodes may have a cumulative detrimental effect on cognitive function is receiving enormous attention in the sports medicine world. So, if you or someone you know has recently had concussion, how do you manage a safe and effective return to activity?

Optimal concussion management strategies involve careful assessment and monitoring of people throughout the return to learn and return to play process. This starts with a re-evaluation within 72 hours of the initial concussive episode, engaging in a period of relative rest, referral to appropriate health care professionals where indicated, and a graded, targeted rehabilitation period. The final stages of concussion management are recovery and return to learn (particularly important for kids) and return to sport.

Re-Evaluation

If you or someone you know, has experienced a concussion recently, the first step in a successful return to normal activity is getting re-evaluated by a suitably qualified health care professional. This will usually involve performing an assessment called the SCOAT6, or Sport Concussion Office Assessment Tool 6. This assessment tool provides a standardised framework to help inform the clinical evaluation process in an office setting. There is also a Child SCOAT6 for use in patients aged 8-12 years, and both can be compared against the results for a SCAT (Sport Concussion Assessment Tool) if one was performed at the time of injury.

There are a lot of factors that can impact the recovery from concussion, including pre-existing physical and mental health factors that should be assessed at re-evaluation. This might include other psychological screening tools, neurological and musculoskeletal assessments and referral to specialist medical doctors if indicated.

Rest and Exercise

It is highly recommended that initial exercise guidance and education on progression be provided by a health care professional such as your doctor or physiotherapist.

Strict rest until the complete resolution of concussion symptoms is not beneficial following sports related concussion. Relative rest, which includes activities of daily living, light physical activity that doesn’t exacerbate symptoms, and reduced screen time, are recommended in the initial 48 hours.

Initial aerobic exercise might include walking or stationary bike. Provided the level of activity does not result in an anything more than a mild exacerbation of symptoms AND symptoms are brief (less than 1 hour), the patient may advance the duration and intensity of activity at the next session. This is referred to as subsymptom threshold, and is a key component of successful and timely return to activity.

“Sleep disturbance in the 10 days AFTER a sports related

concussion is associated with an increased risk of persisting

symptoms and may warrant evaluation and treatment.”

Refer

If you are experiencing persistent concussion symptoms such as neck symptoms, headache, cognitive difficulties, balance disturbances or eye and ear problems, then referral to clinicians with specialised knowledge and skills in concussion management should be considered.

Symptoms that persist for greater than 4 weeks regardless of the age of the patient may be due to a pre-existing condition, concussion-related, or both. Ongoing reassessment with the SCOAT6 combined with targeted clinical evaluations for specific symptoms (eg, headaches, dizziness, cognition) can help determine the cause and guide referrals.

Rehabilitation

Rehabilitation for concussion should be individualised and targeted towards specific symptoms as well as overall recovery. In addition to gradual exposure to increasing volumes of aerobic exercises, specific treatment approaches and exercises may be required to address persistent neck pain, dizziness, headaches, and balance problems. Targeted exercises, soft tissue work, joint mobilisation, and dry needling can all be of benefit during the rehabilitation phase.

Again, regular re-evaluation throughout this period will help to progress the individual based on their presenting signs and symptoms and make suitable adjustments and referrals when indicated.

Recovery

Determining full recovery can be challenging due to the variation in outcome measures available to clinicians. Most clinics favour a combination of subjective, cognitive, and functional outcome measures to determine when recovery has been achieved. Functional outcomes need to be meaningful to the patient and where practicable should include sport and/or lifestyle related activities.

Return to Learn (RTL) and Return to Sport (RTS)

An important consideration for children, adolescents and young adults is the transition back to learning and school following concussion. For those with pre-existing considerations such as a prior learning disability, or in those who have had high acute symptom severity, the RTL process can be more challenging. Following the concepts introduced in ‘Rest and Exercise’, students should be gradually exposed to cognitive work and academic activities, with allowances for appropriate academic support including environmental, physical, curricular, and testing.

Progression through this strategy is symptom dependent, with only mild and brief exacerbations permitted.

Similarly, RTS follows a graduated stepwise strategy with progressive exposure to firstly light, then moderate, aerobic activity. With further resolution of symptoms, and using the subsymptom threshold as a guide, individual sport-specific activities can be introduced, followed by non-contact drills, full contact practice and eventually return to sport.

It is essential that progression through the later stages of RTS be monitored by a health care professional and be undertaken in a graduated fashion. This will provide the athlete with the opportunity to increase confidence throughout recovery, support psychological readiness to return to competitive play, and foster a shared RTS decision-making model.

“While the RTL and RTS strategies can occur in parallel,

student-athletes should complete full RTL before unrestricted RTS”.

How long is it going to take?

The time to return to sport will be impacted by numerous factors, including pre-existing conditions, previous concussion history, severity of the current episode and resolution of symptoms. As a guide, unrestricted return to sport following sports related concussion typically occurs within one month, with an estimated pooled mean time across all people of 19.8 days.

The Take Home.

Concussion is a serious issue that requires careful diagnostic assessment and proactive clinical management to maximizing recovery. We strongly advocate for patient education, return to activity guidance, and symptom-targeted treatment as pillars of successful concussion management and return to learning and sport.

If your looking for some more information on the management of concussion, check out the following links:

Have you recently had a concussion and want to get it sorted? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons and can treat and manage concussion and return to sport with a personalised, goal-oriented and comprehensive management plan.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Daly E., et al. (2022). An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC sports science, medicine and rehabilitation, 14(1), 1-10.
Patricios JS., et al. (2023). Beyond acute concussion assessment to office management: a systematic review informing the development of a Sport Concussion Office Assessment Tool (SCOAT6) for adults and children. British Journal of Sports Medicine, 57(11), 737-748.
Piedade SR., et al. (2021). The management of concussion in sport is not standardized. A systematic review. Journal of safety research, 76, 262-268.
Schneider KJ., et al. (2022). Concussion in sport: the consensus process continues. British journal of sports medicine, 56(19), 1059-1060.
Silverberg ND., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393.
Yeo PC., et al. (2020). A systematic review and qualitative analysis of concussion knowledge amongst sports coaches and match officials. Journal of Sports Science & Medicine, 19(1), 65.

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 01 Dec 2023 04:50:07 GMT

We're working on it....

We're in the process of developing some top notch articles to put in this space. We don't want to serve up something that is below our high standards, so please keep an eye on our social media channels (see below) and come back here soon.

Remedial versus Deep Tissue Massage – What’s the difference?

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 15 Nov 2023 01:54:05 GMT

How to select the right massage, by the right provider, and get a great massage every time.

Massage is a proven beneficial adjunct therapy to assist with recovery from many different types of musculoskeletal problems. Things like back pain, shoulder and neck pain, headaches, even sciatica. But choosing the type of massage you need and finding a professional massage therapist to deliver that technique effectively can be a challenge. So, what is the difference between a deep tissue massage and a remedial massage? And how do you find a reputable provider to get a great massage every time?

What is the difference?

Deep Tissue Massage

Deep tissue massage is a whole-body technique used widely in massage therapy to treat the different layers of tissue. The technique focuses on setting a rhythm and using long, flowing strokes to apply firm pressure to the muscles of the affected area. The repeated use of slow, deep strokes and progressive pressure to relax the superficial layers of tissue allow the therapist to reach the deeper layers of muscle and fascia. Through these techniques trigger points can be released, muscles relaxed, and joint mobility improved. The pressure applied with a deep tissue massage can be uncomfortable, however fans of this technique describe it as ‘good pain’ and contributes to the benefits of the technique.

Remedial Massage

Remedial massage is a more targeted technique, delivered by trained massage therapists, and relies on a skilled assessment of the patient to identify structures that are contributing to pain, discomfort, or tightness. As the name implies, remedial massage aims to remedy problems such as a knee, shoulder, or lower back injury, using a combination of massage and stretching techniques to achieve the best outcomes for the individual.

Because remedial massage is performed with a goal in mind, treatment will often involve a series of sessions where the therapist is constantly assessing the state of the patient and noting any improvements or deterioration.

Treatment may be coordinated with other health care services such as physiotherapy or hydrotherapy, with adjustments to treatment type and frequency to give their patient the best possible chance of recovery.

Which massage technique is best for you?

Everybody is different and treatment should be considerate of the presenting signs and symptoms and health care needs of the individual. Clients should discuss their underlying health conditions and treatment goals with a health practitioner or the treating therapist prior to consenting to treatment.

Deep tissue massage is best for people looking for a whole-body experience and are comfortable with firm pressure and some discomfort to release muscle tension and enhance recovery from physical activity.

People with underlying health conditions such as osteoporosis, cancer, or blood clots, or persons who have chronic pain,

may have adverse outcomes to deep tissue massage.

If you are uncertain if deep tissue massage is appropriate for you, consult with your physiotherapist or GP prior to attending a massage appointment.

Remedial massage is a targeted treatment based on a thorough assessment before treatment techniques are selected. Remedial massage therapists have extra training and skills and utilise these in a multi-disciplinary approach to achieve individual health care goals. Remedial massage is perfect for those people with injuries such as rotator cuff disease , anterior knee pain , and piriformis syndrome. It can greatly benefit recovery following surgery, reduce pain and discomfort associated with some chronic pain presentations, even assist with stress and anxiety.

The Take Home

Both deep tissue and remedial massage therapy are effective forms of treatment for those who suffer a range of musculoskeletal conditions, chronic pain, sleep disturbance, stress, and anxiety. It provides numerous physical and mental health benefits, including reducing inflammation, promoting healing, and improving overall physical and mental well-being. By combining with therapeutic exercise and some simple self-management strategies, clients can maximize the benefits of therapy and maintain long-term improved general health and well-being.

Want to learn more about remedial massage and how it can help? Click here .

Want to learn more about deep tissue massage and how it can help? Click here .

If you're looking for a Remedial Massage Therapist, then give us a call.

We have a fully qualified, experienced massage therapist on staff who works closely with our clinical team to achieve outstanding results.

Give us a call on 08 8945 3799 or Book Online now.

Remedial Massage Therapy, Home Care Packages and the NDIS

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 26 Oct 2023 13:09:22 GMT

Home Care Package Recipients and NDIS clients can access remedial massage therapy services.

The Australian Federal Government Department of Health and Ageing has confirmed that remedial massage is classified as an allied health service and therefore included it under the Home Care Package (HCP) Program if there is an assessed care need for the service.

Remedial massage therapy has long been recognised as an effective health care approach that encompasses a range of techniques to address specific musculoskeletal issues and mental health conditions.

Remedial massage works by stretching and stimulating tight muscles, fascia and trigger points. Techniques transiently increase blood flow to the region and stimulate the nerves in the area. This has been shown to reduce perceived muscle pain, improve strength and power, and reduce anxiety and stress. When combined with other interventions, remedial massage can assist with improving muscle length and function. Regular remedial massage can also facilitate recovery and long-term conditioning by modulating overactive and inactive soft tissues, and reducing fatigue and injury risk.

Remedial massage can be beneficial for a wide range of chronic conditions, many of which are experienced by the elderly and with disability. Conditions such as low back pain, neck pain, arthritis (especially osteoarthritis, rheumatoid arthritis and ankylosing spondylitis), and diabetes can benefit from remedial massage. A qualified massage therapist will undertake a thorough assessment with every patient to determine the best appraoch, and use a patient-centred and collaborative approach to management to achieve the goals of the client.

Home Care Package (HCP) Recipients

Remedial massage is available to HCP recipients through an Approved Provider - that is, a provider that is approved by the Aged Care Quality and Safety Commissioner to deliver Australian Government subsidised home, residential or flexible care services to eligible older Australians.

Approved Providers have responsibility to determine whether a particular service will maintain the care recipient’s capabilities to be well and independent, safe in their home, and connected to their community.

Importantly, a care recipient can access remedial massage therapy services that are provided by a remedial massage therapist through an Approved Provider when the service is:

required due to age-related functional decline and/or client cannot access disability supports
in line with best practice guidance for treatment
delivered by an accredited provider
not concurrently being funded by another government program

Remedial massage therapists can also provide massage services to people living in retirement homes and

aged care facilities who are over 65, who have a HCP.

NDIS Clients

If you are on the NDIS and require support to improve mobility and muscle function, or suffer from chronic pain or joint stiffness, you may be able to access funding for remedial massage therapy under your plan. Essentially, it depends on your individual needs and whether this support is related to your disability and will help you pursue your goals and aspirations.

Accessing remedial massage services via your NDIS fund depends on how your fund is managed.

Self-managed NDIS participants

If you're a self-managed NDIS participant and massage therapy has been recommended under under your capacity-building budget, you can book and pay for remedial massage services and then make a payment request with your fund using the receipt.

Plan-managed NDIS participants

If you're a plan-managed NDIS participant, you will need to speak with your plan manager and determine whether the service is covered under your funding. Your physiotherapist can also liaise with plan managers on behalf of clients to facilitate this and manage the booking and payment.

NDIA-managed participants

NDIA-managed participants must work with registered NDIA providers. Fortunately, Movement For Life Physiotherapy is a registered provider. We recommend you speak with the NDIA to determine whether this service is covered under your funding. Your physiotherapist can also liaise with the NDIA to facilitate this if required.

The best way to find out if massage therapy is covered by your NDIS funding is to chat with your

fund manager to double-check what is and isn’t covered.

Whether you are suffering from chronic pain, anxiety, an injury, or tension in the body, a remedial massage therapy can help as part of a multi-disciplinary treatment plan, individualized to suit your needs and health care goals.

Want to learn more about remedial massage and how it can help? Click here .

If you're looking for a Remedial Massage Therapist, then give us a call.

We have a fully qualified, experienced massage therapist on staff who works closely with our clinical team to achieve outstanding results.

Give us a call on 08 8945 3799 or Book Online now.

The Knee - Osgood Schlatter Disease

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 17 Oct 2023 01:16:02 GMT

Osgood Schlatter disease can seriously impact sports participation.

Osgood-Schlatter Disease (OSD), is the most common osteochondritis affecting the lower limb in adolescents playing sport. OSD is a traction apophysitis (apoph-y-si-tis), meaning inflammation (-itis) of the growth area of the bone where a tendon attaches (the apophysis). It is caused by repetitive traction or overload. Activities such soccer, volleyball, basketball, and gymnastics that involve repetitive jumping, sprinting, and change of direction, produce repetitive stress on the growth plate at the top of the shinbone, causing inflammation, pain, and discomfort.

Previously considered to be self-limiting, OSD can result in prolonged absences from sport, resulting in a shift towards risk factor identification and injury prevention.

Anatomy 101.

The main structure involved in OSD is the tibial tuberosity , a bony prominence at the top of the shinbone (tibia), about 3-5cm below the bottom edge of the kneecap, where the patellar tendon connects. This patella tendon attaches the quadriceps muscles to the shinbone via the patella (kneecap), allowing for knee extension and leg stability. In growing adolescents, the tibial tuberosity is the site of a growth plate, making it particularly vulnerable to repeated mechanical traction. Overuse can result in microvascular tears, growth plate fractures, and inflammation, leading to the classic symptoms of OSD of pain, swelling and tenderness on palpation, and reduced functional activity.

Who gets OSD?

OSD primarily affects growing adolescents during the bone maturation phase of growth, typically

between the ages of 8 -13 years in females and 10-15 years in males.

OSD is more common in boys than girls (ratio of 14:1) and is often seen in young athletes who participate in sports that involve running, jumping, and rapid changes in direction. The highest incidence occurs in soccer players, with OSD accounting for about 13% of all knee pathologies in soccer players aged 13-15. Intrinsic factors such as age, growth spurts, morphology, and gender, can contribute to the development of OSD, as well as extrinsic factors like excessive training (including intensity, volume and type), early specialization, inappropriate footwear, and poor biomechanics.

Diagnosing Osgood Schlatter Disease

Diagnosis typically involves a thorough interview process and clinical examination by a physiotherapist. Activity history leading up to the development of symptoms and the behaviour of symptoms with different activities provide a good indication of whether OSD is the cause of your symptoms. Importantly, there are several other benign conditions that can cause pain in the same region and have similar symptoms, such as patellofemoral pain syndrome , patellar tendonitis, and Sinding-Larsen-Johansson syndrome, as well as more sinister conditions such as bone tumours that need to be considered in the diagnostic process.

Common signs and symptoms of OSD include pain, often severe enough to result in a limp,

and swelling over the bony prominence below the kneecap.

Pain is often worse during or after physical activity, when descending stairs, kneeling, or after prolonged sitting. Patients may also experience tenderness when palpating the tibial tuberosity and an increase in the size of the tibial tuberosity.

Do I need a scan?

Diagnosis of OSD is clinical and based on the presenting symptoms. However, it is recommended that OSD be confirmed by complementary radiological tests, specifically x-ray, ultrasound, and/or MRI, to allow OSD to be differentiated from other pathologies such as fractures, tumours and tendonitis. X-ray is the first choice, as this helps to identify the severity of OSD and grade involvement. Ultrasound is beneficial for monitoring disease progression due to its low cost and ease of access. MRI (Nuclear MR or NMR) has the highest sensitivity to diagnosing early OSD, however it is associated with high cost and limited access, and so is used sparingly. Your physiotherapist can discuss these investigations with you and refer appropriately where indicated.

Treatment

OSD has long been considered a self-limiting condition however this perspective should be challenged. The affected growth plate tissue, known as bradytrophic tissue, is a component of the cartilage matrix that resists mechanical stress and can take 1-2 years to heal in OSD, a long period of time in a developing adolescent!

A comprehensive treatment program is paramount to educate the patient, accelerate symptom resolution and encourage healing, permit modified exercise to continue, and limit deconditioning and skill degradation.

Education, activity modification and therapeutic exercise are the cornerstone of management of OSD. Reduction of load is critical to allow the inflamed apophysis to settle and commence healing. Once symptoms are controlled, the apophysis can be exposed to graded exercise (strengthening and stretching), and eventual return to sport. This permits the underlying matrix of the apophysis to develop tolerance to mechanical load and long-term tissue resilience.

Physiotherapy techniques facilitate this process. Manual therapy, dry needling, taping and bracing can be effective at reducing symptoms, while hydrotherapy and graded land-based exercise programs aimed at improving flexibility, strength, and biomechanics ensure continued exposure to therapeutic load. Pain relief may be prescribed to help manage symptoms, however non-steroidal anti-inflammatory medications (NSAIDs) are discouraged due to their detrimental effects on tendon blood flow and collagen synthesis.

Interventions such as corticosteroid injections, shockwave therapy, and handheld percussive therapies (eg. Theragun), have limited peer reviewed evidence supporting their effectiveness and are not routinely recommended. Surgery is only recommended where conservative treatment has failed and where bone fragments remain after skeletal maturity has occurred.

Remember, no two treatment programs will be alike. Even within OSD, there can be different factors contributing to your presentation. Follow the advice of your physiotherapist, be diligent with your exercises and give it some time. Your symptoms may have developed over a long period of time and will take a similar period to settle and improve.

How long is it going to take?

The prognosis for OSD varies depending on factors such as the severity and duration of symptoms, the age of the patient, and their commitment to treatment. Early intervention, adherence to prescribed exercises, and open communication with healthcare providers can facilitate more effective recovery.

Programs consisting of activity modification, pain monitoring, preogressive strengthening and structured return to sport have been shown to achieve significant improvements in 80% of subjects in 12 weeks, and 90% of cases in 12 months.

Unfortunately, in some cases symptoms will persist until skeletal maturity is reached and the growth plate closes which may take several years.

The Take Home

Osgood-Schlatter Disease is a common and generally self-limiting condition in growing adolescents that can have significant impacts of participation in sport and physical activity if left untreated. In sporting populations the focus should be on risk factor identification and injury prevention. When symptoms do develop, early diagnosis, education, and appropriate physiotherapy intervention is paramount to alleviate symptoms and promote recovery. By working closely with a physiotherapist, young athletes can return to their activities sooner with improved strength, flexibility, and biomechanics, reducing the risk of recurrence.

Got knee pain and want to know the cause? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your knee pain and let you know whether you have Osgood Schlatter disease, patellofemoral pain syndrome, patella tendinopathy, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Bloom OJ & Mackler L (2004). What is the best treatment for Osgood-Schlatter disease?
Clark SC, Jones MW, Choudhury RR, & Smith E (1995). Bilateral patellar tendon rupture secondary to repeated local steroid injections. Emergency Medicine Journal. 12(4):300-1.
Corbi F, Matas S, Álvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, & López-Laval I (2022) Osgood-Schlatter Disease: Appearance, Diagnosis and Treatment: A Narrative Review. Healthcare. 2022; 10(6):1011. https://doi.org/10.3390/healthcare10061011
Gholve PA, Scher DM, Khakharia S, Widmann RF, & Green DW (2007). Osgood Schlatter syndrome. Current Opinion in Pediatrics, 19(1), 44-50.
Kaya DO, & Toprak U (2017). Osgood-Schlatter disease: diagnosis and treatment. EFORT Open Reviews, 2(11), 447-453.
Neuhaus C, Appenzeller-Herzog C, & Faude O (2021). A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Physical Therapy in Sport, 49, 178-187.
Pihlajamäki H, & Visuri T (1999). Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men: surgical technique. The Journal of Bone & Joint Surgery, 81(10), 1426-1432.
Rathleff MS, Winiarski L, Krommes K, et al. (2020). Activity Modification and Knee Strengthening for Osgood-Schlatter Disease: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2020;8(4). doi: 10.1177/2325967120911106
Vaishya R, Azizi AT, & Agarwal AK (2016). Osgood-Schlatter disease: A review of literature. Journal of Clinical Orthopaedics and Trauma, 7(4), 244-248.
Weiner DS, & Macnab I (1971). The "traction" apophysitis. The American Journal of Sports Medicine, 3(3), 152-154.

World Physical Therapy Day 2023

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 08 Sep 2023 06:06:10 GMT

Arthritis and the crucial role Physiotherapy plays

World PT Day is observed to generate awareness about the crucial contribution physiotherapists make to society, enabling people to be mobile, well, and independent. This is observed annually on 8 September. Designated in 1996, World PT Day is promoted by World Physiotherapy .

The focus for this year’s World PT Day on 8 September is arthritis, with an in-depth look at some forms of inflammatory arthritis, including rheumatoid arthritis and non-radiological axial spondyloarthritis.

What is Arthritis?

Arthritis is an umbrella term used to define acute or chronic joint inflammation. According to Arthritis Australia, 1 in 7 Australians, or approximately 3.6 million people, live with some form of arthritis. The cost to our health system is huge. In 2018/2019, the cost of arthritis and associated musculoskeletal conditions was estimated at $14 billion . With an ageing population, knee and hip joint replacements are projected to cost over $5.3 billion a year by 2030 . Many of these costs could be avoided with earlier diagnosis, better access to preventative and multidisciplinary care and support, and investment in high quality research.

What are the symptoms?

Symptoms of arthritis can vary depending on the type of arthritis present. In general, symptoms include pain, swelling, stiffness, and redness which may contribute to reduced function and dexterity. The symptoms of arthritis can vary from week to week, and even from day to day. It can also affect people in different ways and each different arthritic condition can have specific symptoms. However, with the right treatment and approach, you can manage your symptoms and live well.

It's important to emphasise that arthritis isn’t a single condition; there are many different types affecting people of all ages and physical fitness including children, teenagers, and athletes. Some forms of arthritis are more common in older people, some are related to autoimmune responses, while other forms have genetic links.

The role of Physiotherapy

Physiotherapy plays a crucial role in the treatment and management of arthritic conditions. Physiotherapists are primary care practitioners. This means they are able to assess and diagnose their patients within their scope of practice. Physiotherapist's are an integral part of a multi-disciplinary health care team, working closely with doctors, specialists, radiologists, pharmacists and other allied health professionals to optimise the treatment and mangement of arthritis. Their breadth of training and experience enables them to assess arthritic conditions in detail, gauge the impact of symptoms on functional capacity, and effectively guide patients on how to keep active and manage symptoms.

Regular physical activity and exercise are important in the management of all forms of inflammatory arthritis (IA), including rheumatoid arthritis (RA) and axial spondyloarthritis (axial SpA), and offer numerous health benefits. Evidence informed research and clinical experience has clearly demonstrated the importance of staying active and keeping moving with all forms of arthritis. Physiotherapists understand the signs and symptoms of arthritis. This makes them well placed to prescribe, modify, and progress therapeutic exercise, adjust daily activity levels, set achievable personal goals, and help you find the right balance between rest and activity.

Hydrotherapy for Arthritis

One of the best forms of therapeutic exercise for people with all forms of arthritis is hydrotherapy. The temperature of the water combined with the buoyancy that the water provides makes for the perfect environment to soothe sore joints, improve movement and strength, and get the heart rate up. Check out our article on Hydrotherapy for Osteoarthritis for more information.

Different types of Inflammatory Arthritis

There are over 100 different forms of arthritis that affect all parts of the joint and almost every joint in the body. This World Physiotherapy Day, the focus is on just a few of these types.

Rheumatoid Arthritis (RA)

RA is a systemic autoimmune disease that affects the synovial joints . In RA, the immune system attacks the lining of the joints causing inflammation and pain. RA usually affects the small joints of the hands and feet, though the knee and hip joints can also be affected. RA usually affects joints symmetrically (ie. both knees or both hands) and is more common in people who smoke or who have a family history of RA. People with RA and other inflammatory joint disorders have an increased risk of cardiovascular disease (CVD). Healthy lifestyle choices, including regular physical activity, are important in the management of RA to maintain and improve function, manage flare-ups and reduce the risk of CVD.

For more information on RA, click here .

Non-radiographic Axial Spondyloarthritis (nr-axSpA)

Non-radiographic Axial Spondyloarthritis (nr-axSpA) is an autoimmune disease which causes arthritis in the spine and pelvis. While it sounds complicated, non-radiographic Axial Spondyloarthritis simply means that the inflammation does not show up on xray (ie. non-radiological, though it may be seen on MRI), affects the spine (axial) rather than the arms or legs, and can affect the attachment of ligaments and tendons (spondylo) as well as the joint.

People with nr-axSpA should be referred to a physiotherapist to start an individualised, structured exercise programme that is tailored to help maintain spinal flexibility, whole body flexibility, and reduce pain. Even when you have pain, continuing to exercise at levels that suit you has significant benefits.

For more information on Axial SpA, click here .

Juvenile Idiopathic Arthritis (JIA)

JIA is the term given to a group of arthritic conditions that affect children. The term 'idiopathic' means the cause is unknown. So while we know that there is an autoimmune component to JIA that results in the body's immune system attacking healthy cells, the cause for the autoimmune response remains largely unknown. JIA most commonly affects the knees, hips, hands and feet, with typical symptoms including joint pain, swelling, tenderness, stiffness, redness and warmth, as well as fatigue, loss of appetite, and inflammation of the eyes (uveitis). Physiotherapy forms an important role in the management of the symptoms of JIA, assisting you and your child to continue to do the activities they enjoy. Fortunately most children with JIA do not necessarily go on to have arthritis in adulthood.

For more information on JIA, click here .

Osteoarthritis (OA)

Osteoarthritis (OA) is a condition that affects 22% of the population aged over 45. Often described as ‘wear and tear’, OA is known to affect the whole joint including bone, cartilage, ligaments and muscles, and is thought to be the result of a joint working extra hard to repair itself. While any joint can develop OA, the hips, knees, fingers and great toe are most common. The symptoms of OA vary from person to person, even joint to joint in the same person, with the most common symptoms being pain and stiffness of the joints. These sensations are usually worse with activity initially but can be more constant in later disease. Only about a third of people living with OA will get worse over time, and some see an improvement in pain and disability with the correct management. A physiotherapist will be able to guide you on how to keep active.

For more information on OA, check out these articles:

Have you got joint pain or been diagnosed with a form of arthritis ? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and specialists and offer a range of

physiotherapy services to help you manage your arthritis symptoms.

Call now on 08 8945 3799 or book online.

For more information on Arthritis, head to https://arthritisaustralia.com.au/ and follow the social media campaigns #1in7withArthritis and #WorldPTDay .

The Neck - Multifocal glasses and neck pain

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 07 Aug 2023 09:21:59 GMT

How multifocal glasses contribute to neck pain and what you can do.

Have you recently been prescribed multifocal glasses or contact lenses and found you now have neck pain ? You’re not alone. Clinical experience and research-based evidence is demonstrating that, combined with increased computer and personal device usage, multifocal lenses are contributing to an increase in upper cervical postural dysfunction and computer-related neck pain.

How so?

Firstly, some basic anatomy. The spine is divided into 3 sections - the lumbar spine, consisting of 5 vertebrae, the thoracic spine consisting of 12 vertebrae, and the cervical spine, where we have 7 vertebrae. Each vertebra has a body, which is separate from the vertebral body below by a disc. Facet joints are the articulation between any two vertebra, and are responsible for guiding movement and providing a bony limit to movement.

In the cervical spine , facet joints are orientated to allow a variety of movement, including flexion and extension, rotation, and side flexion. The overall S-shape of the entire spine allows these movements to be optimal, with even joint pressure distribution in the neutral position.

Postural Dysfunction

Postural dysfunction has been common in office and computer-based workers for many years. However, there is an increase in occurrence resulting

from greater use of hand help devices across both genders and all age groups.

Postural dysfunction occurs as a result of loss of the normal S-shape of the spine.

When we sit at a computer workstation for long periods, we fatigue. The normal lordosis in the lumbar spine is lost, shifting our body weight and centre of gravity backwards. We counter this by dropping the shoulders forwards and ‘poking’ the chin. In the cervical spine, this posture increases extension in the upper part of the neck (just below the head) and flexion in the lower part of the neck. This redistributes pressure on the facet joints, and after a while they get unhappy, resulting in pain and stiffness. If repeated day in day out, the body starts to adapt, increasing the length of some muscles and shortening others, and resulting in weakness in key postural muscles.

What’s the impact of Multifocal lenses?

In simple terms, multifocal glasses (or contact lenses) have a lens that transitions to allow for both short-sighted and long-sighted issues. The bottom half of the lens is great for close vision, like reading a book or looking at a screen, while the upper part of the lens adjusts for long vision, such as driving. For the office worker, problems can arise in the neck because the wearer can no longer just move the eyes (or the gaze) up to see the top half of the screen. To do so can be blurry due to the different correction in the lens. Instead, the wearer must tilt the head upward so that they can see the right part of the screen through the right lens.

Consider this. For most of us, multi-focal glasses are something that come with advancing age and, if we’ve been in an office job for a few years or more, postural dysfunction may already be well established. Add to this greater upper cervical extension to see through the right part of the multi focal lens, and the neck gets pretty grumpy, pretty quickly.

Signs and symptoms

Computer related neck pain is a chronic condition that arises gradually, becoming more persistent and difficult to manage without help. Initially, pain and discomfort are intermittent, with onset generally later in the day or evening, with tightness in different neck muscles. Some relief can be found with heat, massage and stretching.

Overtime, as postural adaptations progress and muscles become weaker, joint loading becomes more sustained, resulting in persistent pain, increasing neck stiffness, loss of range of movement and difficulty with work and home activities. Posturally there is loss of the normal S-shape of the spine.

Patients with this type of neck pain have flattening of the lumbar lordosis, rounding off the shoulders and a forward head, or ‘poking chin’ position.

Oh, and they possibly changed to multifocal lenses in the past 6-12 months!

The Solution.

There is plenty that can be done for this type of neck pain and, while it can take a while, good outcomes are possible. Firstly, consider a simple ergonomic assessment of your workstation. These can be done by most good Physio’s (and yes, we can do these!). Updating and adjusting your workspace can have an immediate impact on symptoms and improve productivity and happiness at work.

Next, see a Physio. Some local treatment will assist with symptom management, freeing up stiff joints and loosening tight muscles. Massage , dry needling, and manual therapy all have a role here, with good short-term results.

Finally, exercise. This cannot be emphasised enough. Addressing those muscle imbalances and restoring normal posture is the key to long term improvement. We’re talking deep neck flexors, scapula stabilisers and core stability. As a starter, we might try some chin tucks, standing rows and some planks to engage key postural muscles. Your neck will be better for it, as will your shoulders and lower back.

The Take Home.

Computer related neck pain is a common presentation, exacerbated by the increased prescribing and usage of multifocal lenses, and increasing in frequency in the community with the increase in handheld device usage. Acute symptoms of pain and stiffness respond well to Physiotherapy intervention, while exercise forms the bedrock of long-term management.

Do you have neck pain? Think it might be related to your new glasses or workstation?

Give us a call. We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons

and can treat and manage neck pain with a personalised, goal-oriented and comprehensive approach.

Call now on 08 8945 3799 or book online.

Sources

Abbas RL, Houri MT, Rayyan MM, Hamada HA, & Saab IM (2019). Effect of unifocal versus multifocal lenses on cervical spine posture in patients with presbyopia. International Journal of Occupational Safety and Ergonomics, 25(1), 148-152.
Bartha MC, Allie P & Kokot D. (2020). Field Observations of Placement for Large-Panel Flat and Curved Displays for Presbyopic and Prepresbyopic Computer Users. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting (Vol. 64, No. 1, pp. 526-530).
Becker M, Rothman J, Nelson AJ, Freedland R, Garcia D, Feit L, Barth J and Sabini R (2007). The effects of multifocal refractive lenses on occipital extension and forward head posture during a visual task. Ergonomics, 50(12), pp.2095-2103.
Friedrich M, Kothe J, Seidel E and Beyer L (2014). Relation between head and eye movement and neck and shoulder complaints in presbyopic VDU users. International Musculoskeletal Medicine, 36(1), pp.26-31.
Poursadegh M, Azghani MR, Chakeri Z, Okhravi SM & Salahzadeh Z. (2023). Postures of the Head, Upper, and Lower Neck in Forward Head Posture: Static and Quasi-static Analyses. Middle East Journal of Rehabilitation and Health Studies, (In Press).
Sageer, MM. Study on prevalence of forward head posture among young individuals wearing eye glasses. www.ijmaes.org, www.jmmodernpublishers.ijmaes.org.

The Hand - Gamekeeper's Thumb

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 07 Aug 2023 03:00:23 GMT

Gamekeeper's thumb doesn't need to cause long term disability and pain.

The top end has an active recreational and sport shooting community and they can be at risk of some unexpected injuries.

Gamekeepers thumb is a chronic, overuse condition common in shooters that affects a ligament in the hand, resulting in pain and dysfunction of the thumb.

While poor technique can result in an acute injury, this is more common in other sports and occupations, particularly snow skiing ( Skier’s thumb ) and football codes (jersey thumb).

A little bit of anatomy.

The hand is a complex area, with plenty of small bones, ligaments, muscles, and tendons contributing to the high dexterity and functionality of the hand. To keep it simple, we have 2 rows of carpal bones in the wrist, metacarpals (long bones of the hand) and the phalanges (finger bones).

The point where the metacarpal and the phalanx meet is called the metacarpophalangeal joint (MCPJ for short). The first MCP joint has a ligament either side, called a collateral ligament, and it is the inside ligament, the ulnar collateral ligament, that is injured with Gamekeeper’s thumb.

Mechanism of Injury

When a gun is fired, the recoil of the weapon imparts an abduction force to the thumb carpometacarpal joint of the trigger hand. This force can disrupt fibres in the ulna collateral ligament, resulting in microscopic damage. Poor technique can exacerbate the force and increase fibre disruption.

Given adequate recovery time and protection, the ligament can heal. However, if exposed to repeat trauma without adequate healing time, micro trauma progresses, scar tissue infiltrates the ligament, and the overall capacity of the ligament to withstand the force of the recoiling weapon can be compromised. As a result, pain and dysfunction can develop, and in some circumstances, complete ligament rupture can occur from repeat exposure.

Early Assessment

We’re big advocates for early intervention, as it generally results in superior outcomes to a wait and see approach.

Gamekeeper’s thumb is no different. People who sustain this injury will present with localised pain and joint instability, particularly with simple tasks requiring pincer movements such as holding water bottles or preparing meals. If the injury has had an acute mechanism, then there may still be bruising, swelling and inflammation present.

Diagnosis of Gamekeeper’s thumb is relatively straight forward – history of activity exposure, mechanism of injury, palpation and some joint stress tests are usually enough to formulate a basic diagnosis. However, like many injuries, the devil is in the detail, and with Gamekeeper’s thumb there several important considerations including the degree of ligament damage, involvement of the volar plate, a Stenar lesion, or an avulsion fracture.

Do I need an Xray?

Yep. Xray remains a keystone of management. Ligaments join bone to bone, and it is not uncommon for a bone injury to occur at the same time, particularly in an acute presentation. The presence of a fracture will change management, so it is important to have the thumb x-rayed at a minimum, with consideration given to ultrasound and MRI in some circumstances.

Stener lesion

A Stenar lesion occurs when both the proper and accessory components of the ligament have been ruptured and the ligament retracts. This can be assessed clinically by checking joint thumb MCPJ stability in 30 degrees of flexion and in full extension and comparing stability with the uninjured side. If a Stenar lesion is suspected, healing of the ligament is unlikely and referral to a hand surgeon is indicated.

Non-surgical management and Return to Activity

If the ligament has been partially torn, and there are no other complications identified, management will involve immobilisation in a thumb spica splint that includes the wrist for a period of about a week followed by a thumb spica that allows movement of the distal thumb only for a further 6 weeks.

We like to use Donjoy Exos splints - they are lighter, easily modifiable, and more comfortable (and you can get them wet, an important consideration in the tropics!).

There is good evidence for early controlled active movement in the management of Gamekeeper’s thumb. We recommend physiotherapy commence at about the 4 week mark, however it is important to keep the splint on at all other times. After the 6 week mark, the splint can be reduced to high risk situations only, such as return to work or sport. Ongoing physiotherapy involves joint mobilisation and tendon gliding, with strengthening work from about the 8 week mark. Unrestricted activity is usually not permitted until about the 12 week mark.

In chronic presentations, assessment of sporting technique is an important consideration to ensure future risk of Gamekeeper’s thumb developing are mitigated.

Surgical Treatment

Referral to a hand surgeon is warranted in most cases for an opinion on best management. Surgery is still considered the gold standard in management of higher grade Gamekeeper’s thumb injuries.

Surgery is indicated where:

Assessed joint stability is grossly unstable;
A displaced avulsion fracture is identified, and/or
A Stener lesion is suspected.

Ensuring these are suitably managed is essential for regaining normal thumb function and maintaining joint stability for the longer term.

Following surgery, management is similar to non-surgical management, albeit with some variations in time frames dependent on the surgeon’s protocols.

The Take Home

Gamekeeper’s thumb has a serious risk of disabling chronic instability if not treated adequately. It requires careful assessment and management to ensure function is returned to normal and potential complications are considered and managed. In most cases, referral to a specialist hand surgeon or sports physician for opinion is warranted. Importantly, function can be improved, and rehabilitation times reduced for Gamekeeper’s thumb through protective joint mobilisation and graded strengthening programs.

Have you injured your thumb or have thumb pain and disability from work or sport?

We can help. We're part of a well connected group of local health care providers including surgeons, doctors

and allied health care providers who love helping people get back to doing what they enjoy most.

Give us a call on 08 8945 3799 or book an appointment online.

Sources

Bordet B, Borne J, Ponsot A, Chaillot PF, Fantino O (2022). Ultrasound of the Metacarpophalangeal Joint of the Thumb. In: Apard T, Brasseur JL. (eds) Ultrasonography for the Upper Limb Surgeon. Springer, Cham. https://doi.org/10.1007/978-3-030-84234-5_20
Chang AL, Merkow DB, Bookman JS & Glickel SZ. (2023). Thumb Metacarpophalangeal Joint Ulnar Collateral Ligament Injuries: Management and Biomechanical Evaluation. Journal of the American Academy of Orthopaedic Surgeons, 31(1), 7-16.
Fricker, R., & Hintermann, B. (1995). Skier’s thumb: Treatment, prevention and recommendations. Sports Medicine, 19, 73-79.
Gibbs DB and Shin SS (2020). Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. The Orthopaedic Journal of Sports Medicine, 8(7). DOI: 10.1177/2325967120935063
Gil JA, Ebert K, Blanchard K, Goodman AD, Crisco JJ & Katarincic JA (2019). Efficacy of a radial-based thumb metacarpophalangeal-stabilizing orthosis for protecting the thumb metacarpophalangeal joint ulnar collateral ligament. Journal of Hand Therapy, 32(1), 80-85.
Harley, B. J., Werner, F. W., & Green, J. K. (2004). A biomechanical modeling of injury, repair, and rehabilitation of ulnar collateral ligament injuries of the thumb. The Journal of hand surgery, 29(5), 915-920.
Ingari, J., & Blum, G. (2010). Ulnar Collateral Ligament Injuries of the Thumb (Gamekeeper’s Thumb, Skier’s Thumb). Essential Orthopaedics, 345.
Kukadia J and Ashwood N (2017) Gamekeepers Thumb. Trauma, 19(1) 11–20. DOI: 10.1177/1460408616648064
Lark, M. E., Maroukis, B. L., & Chung, K. C. (2017). The Stener lesion: historical perspective and evolution of diagnostic criteria. Hand, 12(3), 283-289.
Le Lardic, C (2019). Stiffness and pain of the thumb after sprain of the ulnar collateral ligament of the metacarpophalangeal (UCL).
Madan SS, Pai DR, Kaur A and Dixit R (2014). Injury to Ulnar Collateral Ligament of Thumb. Orthopaedic Surgery, 6:1–7. DOI: 10.1111/os.12084
Patel S, Potty A, Taylor EJ and Sorene ED (2010). Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strategies in Trauma and Limb Reconstruction, 5:1–10. DOI 10.1007/s11751-010-0079-7
Rocchi L, Merolli A, Morini A, Monteleone G and Foti C (2013). A modified spica-splint in postoperative early-motion management of skier's thumb lesion: a randomized clinical trial. European Journal of Physical and Rehabilitation Medicine, 50(1), 49-57.

The Hand - Skier's Thumb

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 24 Jul 2023 08:19:41 GMT

It's not just skiers who get Skier's thumb.

Even though we live in the tropics, there is a big cohort of skiers and snowboarders in Darwin that venture to northern hemisphere winters or hang out for a trip to Perisher or Mount Buller in the Aussie winter to get in some turns.

Part and parcel with winter sports are injuries, and skier’s thumb is one of the more common presentations we see.

Named due to its propensity in skiers, this injury occurs when the thumb is pulled backwards, often when falling onto the hand, and exacerbated by the ski pole. Of course, skier’s thumb is not just isolated to skiers. This mechanism of injury can occur in many activities, including shooting (thus the other name for the same injury, Gamekeeper’s thumb, though the mechanism of injury is chronic overload), hockey, basketball, football and in work-related incidents.

A little bit of anatomy.

The point where the metacarpal and the phalanx meet is called the metacarpophalangeal (abbreviated to 'MCP') joint. The first MCP joint has a ligament either side, called a collateral ligament, and it is the inside ligament, the ulnar collateral ligament, that is injured with Skier’s thumb .

Skier’s thumb is a spectrum of injury, ranging from mild sprain (Grade 1) through to complete rupture (Grade 3) of the ulnar collateral ligament (UCL) of the thumb’s MCP joint. It occurs when the thumb hyperabducts (moves outwards) comparative to the hand and is most common in skiers who fall on their outstretched hand while still holding the ski pole.

Early Assessment

We’re big advocates for early intervention, as it generally results in superior outcomes to a wait and see approach.

Skier’s thumb is no different - get it seen early! People who sustain this injury will present with localised pain, particularly with simple tasks like holding water bottles or preparing meals, and joint instability. If the injury is still in the acute phase (ie. the first few days), then there will be bruising, swelling and inflammation.

Diagnosing Skier’s thumb is relatively straight forward – mechanism of injury, palpation and some joint stress tests are usually enough to formulate a basic diagnosis. However, like many injuries, the devil is in the detail, and with Skier’s thumb there several considerations including the degree of ligament rupture, involvement of the volar plate, a Stener lesion, or an avulsion fracture, as well as ruling out other potential causes of pain.

Do I need an Xray?

Yep. Xray remains a keystone of management. Ligaments join bone to bone, and it is not uncommon for a bone injury to occur at the same time. Presence of a fracture will change management, so it is important to have all presentations of Skier’s thumb x-rayed at a minimum, with consideration given to ultrasound and MRI in some circumstances.

Stener lesion

A Stener lesion occurs when both the proper and accessory components of the ligament have been injured and the ligament retracts. This can be assessed clinically by checking thumb MCP joint stability in 30 degrees of flexion and in full extension and comparing stability with the uninjured side. If a Stener lesion is suspected, healing of the ligament is unlikely and referral to a hand surgeon is indicated.

Non-surgical management and Return to Activity

We like to use Donjoy Exos splints - they are lighter, easily modifiable, and more comfortable (and you can get them wet, an important consideration in the tropics!).

Some physiotherapy can commence at about the 4 week mark, however it is important to keep the splint on at all other times. After the 6 week mark, the splint can be reduced to high risk situations only, such as return to work or sport. Ongoing physiotherapy involves joint mobilisation and tendon gliding, with strengthening work from about the 8 week mark. Unrestricted activity is usually not permitted until about the 12 week mark.

Surgical Treatment

Referral to a hand surgeon is warranted in most cases for an opinion on best management and is still considered the gold standard in management of Skier’s thumb.

Surgery is indicated where:

Assessed joint stability is grossly unstable;
A displaced avulsion fracture is identified, and/or
A Stener lesion is suspected.

Ensuring these are suitably managed is essential for regaining normal thumb function and maintaining joint stability for the longer term.

Following surgery, management is similar to non-surgical management, albeit with some variations in time frames dependent on the surgeon’s protocols.

The Take Home

Skier’s thumb has a serious risk of disabling chronic instability if not treated adequately. It requires careful assessment and management to ensure function is returned to normal and potential complications are considered and managed. In most cases, referral to a specialist hand surgeon or sports physician for opinion is warranted. Importantly, function can be improved, and rehabilitation times reduced for Skier’s thumb through protective joint mobilisation and graded strengthening programs.

Have you fallen and injured your thumb or sprained the thumb joint playing sport?

We're part of a well connected group of local health care providers including surgeons, doctors

and allied health care providers who love helping people get back to doing what they enjoy most.

Give us a call on 08 8945 3799 or book an appointment online.

Sources

Adler, T., Eisenbarth, I., Hirschmann, M. T., Müller‐Gerbl, M., & Fricker, R. (2012). Can clinical examination cause a Stener lesion in patients with skier's thumb?: a cadaveric study. Clinical Anatomy, 25(6), 762-766.
Anderson, D (2010). Skier’s Thumb. Australian Family Physician, 39(8), 575-577.
Gibbs DB and Shin SS (2020). Return to Play in Athletes After Thumb Ulnar Collateral Ligament Repair With Suture Tape Augmentation. The Orthopaedic Journal of Sports Medicine, 8(7). DOI: 10.1177/2325967120935063
Fricker, R., & Hintermann, B. (1995). Skier’s thumb: Treatment, prevention and recommendations. Sports Medicine, 19, 73-79.
Kukadia J and Ashwood N (2017) Gamekeepers Thumb. Trauma, 19(1) 11–20. DOI: 10.1177/1460408616648064
Lark, M. E., Maroukis, B. L., & Chung, K. C. (2017). The Stener lesion: historical perspective and evolution of diagnostic criteria. Hand, 12(3), 283-289.
Le Lardic, C (2019). Stiffness and pain of the thumb after sprain of the ulnar collateral ligament of the metacarpophalangeal (UCL).
Madan SS, Pai DR, Kaur A and Dixit R (2014). Injury to Ulnar Collateral Ligament of Thumb. Orthopaedic Surgery, 6:1–7. DOI: 10.1111/os.12084
Patel S, Potty A, Taylor EJ and Sorene ED (2010). Collateral ligament injuries of the metacarpophalangeal joint of the thumb: a treatment algorithm. Strategies in Trauma and Limb Reconstruction, 5:1–10. DOI 10.1007/s11751-010-0079-7
Rocchi L, Merolli A, Morini A, Monteleone G and Foti C (2013). A modified spica-splint in postoperative early-motion management of skier's thumb lesion: a randomized clinical trial. European Journal of Physical and Rehabilitation Medicine, 50(1), 49-57.

The Knee - Patellofemoral Pain Syndrome

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 17 Jul 2023 05:27:13 GMT

PFPS is a common yet complex cause of anterior knee pain.

Patellofemoral pain syndrome (PFPS) is one of the most common causes of anterior knee pain encountered in the physiotherapy setting, affecting more than 20% of adolescents and adults in the general population. Sometimes used as an umbrella term to describe pain arising from the patellofemoral joint (PFJ), PFPS is characterised by insidious onset pain associated with deep knee flexion activities (eg, ascending and descending stairs, squatting). PFPS is thought to precede patellofemoral osteoarthritis, though the evidence on this is conflicted.

Left untreated, PFPS is associated with persistent or progressive knee symptoms, impaired function, and reduced quality of life.

Anatomy 101.

The knee consists of 3 joints – the tibiofemoral joint, the patellofemoral joint (PFJ) and the superior tibiofibular joint. The patellofemoral joint (PFJ) plays a critical role in knee joint function. Attaching to the quadriceps tendon above the knee and the patella tendon below, the patella acts as a complex lever to enhance the mechanical advantage of the quadriceps muscle. By pulling the patella back against the knee joint, a reaction force is produced that increases the lever arm of the knee extensors. In a normal healthy knee, the contact point between the patella and the knee joint can absorb and distribute this pressure effectively, allowing us to walk, run, jump, squat and play sport.

Who gets PFPS?

PFPS is common, affecting 1 in 5 people at some point in their lifetime and is more prevalent in adolescents and females.

In adolescents, PFPS is often associated with growth periods that cause muscle imbalances. This period of life often coincides with increasing exposure to physical activity and/or study, which can contribute to increased PFJ load. In females, body shape has been associated with altering the angle of pull on the PFJ, increasing lateral translation of the patella and increasing contact pressure in the joint.

What causes PFPS?

Patellofemoral pain syndrome is one cause of anterior knee pain. PFPS results from the development of pathology in the articular cartilage that lines the undersurface of the kneecap (patella) and/or the femur. Altered contact pressure in the joint results in breakdown of the articular cartilage structure. This might be the result of acute trauma (ag. A heavy fall onto the kneecap that results in bone bruising), but is more commonly due to a sudden increase in activity, or from biomechanical issues causing low grade repetitive trauma (eg. poor footwear, hip and gluteal weakness). The development of small cracks, or fissures, in the cartilage alters the capacity of the PFJ to distribute force effectively, resulting in further degenerative change, pain, and restricted activity.

What to do, what to do…

There is a plethora of causes of anterior knee pain and so a diagnosis of PFPS requires patience and skill. Your physiotherapist will often spend a lot of time asking you about how your knee pain developed, how it has behaved over time, what aggravates it and what relieves it. PFPS often presents with pain behind the kneecap, particularly with deep squat or lunge, ascending or descending stairs, or sitting with the knees bent.

Pain may refer into the back of the knee and some activities (such as ascending stairs) may be associated with crunchiness, or crepitus, in the knee.

A physical assessment will include observing how the knee joint behaves with activities such as walking, squatting, kneeling, and jumping, paying particular attention to what your kneecap wants to do. Assessing the knee for swelling, checking joint range of motion, and palpating different structures will help diagnose PFPS. Your physio will also assess your foot and ankle, hip, and lower back, as there is strong evidence for these structures contributing to the development of PFPS.

What about an xray?

In some instances, further investigations are required. Xray’s help determine if there is bone damage or wear in the joint, while MRI can aid with the diagnosis and prognosis of bone and soft tissue problems. Your physio can assist with a referral for these or liaise with your GP for other investigations if required (such as blood tests).

The best treatment? Exercise

Management of PFPS requires patience and persistence. The three key things to address with PFPS are:

Change activity to reduce the load across the PFJ. This doesn’t mean stopping activity. Maintaining some load across the joint is crucial for bone and joint health. You need to reduce activity enough to allow the tissue to start to recover. Stopping activity and ‘resting’ will just prolong the pain!
Address weaknesses in the quadriceps, hip joint, and trunk. There is strong evidence linking hip joint weakness and reduced core strength to PFPS, and exercise therapy is the key in the rehabilitation program. Poor proximal control results in altered biomechanics at the knee joint, resulting in muscle imbalances and altered joint load.
Look at your feet. If you tend to pronate (ie. Feet roll inwards when weight bearing) then this is probably contributing to your symptoms. Often some simple off-the-shelf orthotics along with strengthening exercises will help here, but if more precise control is indicated then our friends at Swan Podiatry will be happy to help.

Treatment and management must be specific to your presentation and prescribed by someone who knows what they are doing. Soft tissue techniques, dry needling , taping, and bracing all play a role in resolving PFPS.

Remember, no two treatment programs will be alike. Even within PFPS, there can be different factors contributing to your presentation. Follow the advice of your physiotherapist, be diligent with your exercises and give it some time. Your symptoms may have developed over a long period of time and will take a similar period to settle and improve.

The Take Home

Patellofemoral Pain Syndrome is a common, complex, multi-factorial problem that requires a whole-of-person approach. If the focus is just on the knee, you’re not likely to get better. Assessment must include hip and core strength testing, load modification, hip strengthening, and functional exercises. Don’t rely on generic information - get the opinion of an expert and stick to the management plan. Most PFPS can be fixed, but you need to be patient and committed.

If your looking for some more information on the management of Anterior Knee Pain, check out this blog post . We also have resources from the Journal of Orthopaedic Sports and Physical Therapy here:

Got anterior knee pain and want to know the cause? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your anterior knee pain and let you know whether you have patellofemoral pain syndrome, patella tendinopathy, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Wrist - Carpal Tunnel Syndrome

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 19 Jun 2023 01:58:03 GMT

Numbness and weakness in the hand are common signs of carpal tunnel syndrome.

“A burning, cramping feeling in my elbow and wrist, and numbness in two fingers”.

That’s how one patient described her early experience with Carpal tunnel syndrome (CTS), an entrapment neuropathy caused by compression of the median nerve as it travels through the carpal tunnel. It is the most common nerve compression disorder in the general population, accounting for 90% of all neuropathies, and is characterised by wrist and hand pain, numbness, pins and needles, and weakness.

Anatomy 101

The carpal tunnel is a narrow, rigid structure in the wrist formed by the carpal bones and a strong ligament called the transverse carpal ligament. The primary role of the carpal tunnel is to protect the median nerve and flexor tendons that pass through it. The median nerve is responsible for providing sensation to the thumb, index, and middle fingers and controlling the muscles at the base of the thumb. Due to its confined space, the carpal tunnel is susceptible to compression or entrapment, leading to carpal tunnel syndrome. You can see the anatomy of the carpal tunnel here .

The carpal tunnel maintains a relatively constant tissue fluid pressure level of between 2.5 and 13mmHg. Under some conditions, the pressure can exceed normal health levels, impeding blood flow and nerve conduction, and causing nerve dysfunction, swelling, and scarring.

Who gets it?

CTS affects approximately 3-6% of the adult population, with females impacted at 3 times the rate of men.

The majority of CTS cases are chronic and idiopathic, meaning that there is no known cause for the symptoms.

There are some known risk factors for CTS, being:

Female gender (with peak occurrence between 45-54 years of age)
Increasing age
Obesity
Thyroid disease
Diabetes
Pregnancy

With regards to repetitive stress/strain, the literature does show some association between CTS and the use of vibratory tools, repetitive wrist flexion and extension, and repetitive loading through the hand.

Acute CTS is less common and is usually the result of associated trauma resulting in acute swelling or haematoma formation in the carpal tunnel. Atraumatic causes include septic arthritis, soft tissue infections, and calcifying tendinitis. Acute presentations should be treated urgently at the nearest hospital or medical facility.

Diagnosing carpal tunnel syndrome

CTS can often be diagnosed in the clinical setting by a trained medical professional. A thorough medical history will assist with identifying symptoms associated with CTS including:

Duration and location of symptoms;
Timing of symptoms (symptoms increasing at night, for example);
Functional impact (reduced grip strength, difficulty driving), and;
Presence of known risk factors (eg. pregnancy, diabetes, rheumatoid arthritis).

A physical examination will assess for signs of CTS, including muscle wasting, reduced grip strength, sensor examination and some special tests such as Tinel’s sign and Phalen’s manoeuvre to assess nerve irritation.

Nerve conduction studies or electromyography may be necessary to confirm the diagnosis and should be performed if surgery is being considered. These studies measure the strength and speed of impulses propagated down the length of a peripheral nerve and are usually reduced in CTS.

Conditions that may present similarly to CTS and should be ruled out during the assessment process include:

Other median nerve entrapments syndromes
Pronator teres syndrome
Arthritis
Nerve root compression at the neck level.

Do I need a scan?

Imaging studies like X-rays, MRIs, or ultrasounds are not typically required for CTS diagnosis. However, they may be utilized if other conditions need to be ruled out or if conservative treatments fail to provide relief. Your physiotherapist can advise you on this and even refer you for some scans where indicated.

How do I fix it?

For mild to moderate cases and those CTS cases suggestive of the possibility of remission (such as with pregnancy-related CTS), evidence-based treatment often starts with conservative approaches, including activity modification and wrist splinting. Physiotherapy techniques, such as soft tissue therapy, manual therapy, nerve gliding exercises, and graded functional strength and conditioning, can help alleviate symptoms and prevent recurrence.

In chronic, persistent cases, CTS symptoms typically escalate over the longer-term despite conservative treatment, and more invasive treatment approaches are often required. These might include corticosteroid injections for temporary relief of pain and paraesthesia, and/or surgical release to decompress the median nerve (see below). Alternative therapies, such as acupuncture or shockwave therapy, and oral anti-inflammatory medications have limited evidence supporting their effectiveness in the management of CTS.

How long is it going to take?

The prognosis for CTS varies depending on factors such as the severity, duration of symptoms, and the patient's commitment to treatment. Early diagnosis and intervention is paramount. Kaplan et al identified 5 factors that contributed to non-operative outcomes:

Age over 50
Duration of symptoms > 10 years
Constant paraesthesia
Stenosing flexor tenosynovitis
Positive Phalen’s test in < 30secs

Patients with two or less of these factors had a greater than 83% chance of a successful outcome with conservative management. This reduced to 7% if three factors were present and to 0% if four or more were present. For these presentations, surgery should be considered.

Will I need surgery?

Surgery is usually reserved for recalcitrant cases and/or severe symptoms and involves release of the transverse carpal ligament. This relieves pressure within the carpal tunnel and decompresses the median nerve. Surgery can be performed using an open approach or endoscopically, with long term outcomes similar regardless of the approach.

Following surgery, physiotherapy is strongly recommended to assist with regaining wrist and hand strength, normalising median nerve mobility and restoring normal upper limb function.

The Take Home

Carpal tunnel syndrome is a common, disabling condition affecting the hand and wrist. In mild and moderate cases, early intervention and a comprehensive treatment plan, including physiotherapy and lifestyle modifications, are crucial for managing symptoms and preventing recurrence. Many cases will progress to requiring surgical release to manage symptoms and restore normal nerve function. Optimal functional outcomes can be achieved with a multi-disciplinary healthcare approach involving your doctor, physiotherapist and surgeon.

Do you have pain or tingling in your wrist and hand? Concerned you might have carpal tunnel syndrome?

Give us a call on 08 8945 3799 or book an appointment online.

We love wrist and hand problems and we love helping people with all sorts of wrist problems get back to doing what they enjoy most.

Sources

American Academy of Orthopaedic Surgeons. (2016). Management of carpal tunnel syndrome evidence-based clinical practice guideline. Retrieved from https://www.aaos.org/globalassets/quality-and-practice-resources/carpal-tunnel/carpal_tunnel_syndrome_cpg_10.31.16.pdf
Atroshi, I., Gummesson, C., Johnsson, R., Ornstein, E., Ranstam, J., & Rosén, I. (1999). Prevalence of carpal tunnel syndrome in a general population. JAMA, 282(2), 153-158.
Bland, J. D. (2007). Carpal tunnel syndrome. BMJ, 335(7615), 343-346.
Huisstede, B. M., Hoogvliet, P., Rands, dorp, C. S., & Glerum, S. (2010). Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments—a systematic review. Archives of Physical Medicine and Rehabilitation, 91(7), 981-1004.
Kaplan, S. J., Glickel, S. Z., & Eaton, R. G. (1990). Predictive factors in the non-surgical treatment of carpal tunnel syndrome. The Journal of Hand Surgery: British & European Volume, 15(1), 106-108.
Ostergaard, P. J., Meyer, M. A., & Earp, B. E. (2020). Non-operative treatment of carpal tunnel syndrome. Current reviews in musculoskeletal medicine, 13, 141-147.
Padua, L., Coraci, D., Erra, C., Pazzaglia, C., Paolasso, I., Loreti, C., ... & Hobson-Webb, L. D. (2016). Carpal tunnel syndrome: clinical features, diagnosis, and management. The Lancet Neurology, 15(12), 1273-1284.
Sevy JO, Varacallo M. Carpal Tunnel Syndrome. 2022 Sep 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28846321.
Zimmerman M, Gottsäter A, Dahlin LB. Carpal Tunnel Syndrome and Diabetes—A Comprehensive Review. Journal of Clinical Medicine. 2022; 11(6):1674. https://doi.org/10.3390/jcm11061674

Lower Leg - Calf Muscle Strain Injury

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 16 Jun 2023 05:49:46 GMT

Calf muscle injuries can be complex and have a high rate of reinjury.

If you’ve ever popped a calf, you’ll know the shock and accompanying searing pain that comes with it, like someone has thrown a rock at you as hard as possible and struck you in the back of the leg. Calf muscle strains are common in sports that require maximum sprinting, acceleration, agility and change of direction – think AFL, soccer, squash, and tennis – and has been coined an ‘old man’s injury’ due to its frequency in middle aged men trying to get fit again.

A little bit of anatomy

The calf muscle complex is a vital biomechanical component of walking, running and weight bearing activities. Composed of the gastrocnemius (pronounced ga-strok-nee-mee-uhs ), soleus and plantaris muscles, the calf can generate huge amounts of force and counter large reaction loads when landing from a jump or changing direction.

While all calf muscles are susceptible to injury, in most sports the gastrocnemius is most frequently strained due to it being a bi-articular (or two joint muscle). The exception to this is AFL players, where studies have shown that greater than 80% of calf muscle injuries involve the soleus muscle ² .

You can see the anatomy of the calf muscles here .

Risk factors and injury prevention

Like all injuries, there exists both intrinsic and extrinsic risk factors for the development of a calf muscle strain injury. Some of these are modifiable, while others can’t be changed.

Intrinsic risk factors for calf muscle injury include:

Age – This is why it’s often termed an ‘Old man’s injury’. There is strong evidence associating increasing age with calf muscle injury, particularly in AFL and soccer ^1,3,4,5 .
Previous History – yep, like most soft tissue injuries, if you’ve had a calf strain previously, you have a higher risk of future injury in the same muscle ^1,3,4,5,6,7 .
Other injuries – there is some weak evidence that other lower limb injuries such as adductor and hamstring strains, and knee injuries, can predispose athletes to future calf muscle strain injury ^1,3,5 .

Extrinsic risk factors include:

The type and demands of the sport being played ^1,3,4,5 .
Time of the sporting season ^1,3,4,5 .
Training error and cumulative fatigue ^1,3,4,5 .

Injury prevention involves identifying risk factors and ensuring training and game exposure is graded and relevant to the individual’s age, training history, and past injury history. Training volumes should be increased gradually, with progressive exposure to loads encounter routinely by the athlete in their chosen field. Education plays an important part in ensuring adequate recovery periods are recognised and that soft tissue therapies are used judiciously as an injury risk reduction tool.

Diagnosing calf muscle strain injury

While a diagnosis of calf muscle injury might appear straight forward, there are always other potential injuries and contributing factors that need consideration. Direct injuries (such as a contusion), delayed onset muscle soreness (DOMS), and Achilles tendon injuries share some similar signs and symptoms, while the lumbar spine can refer pain to the calf region and should form part of the assessment process.

Do I need a scan?

Not immediately! In most instances it is reasonable to wait a few days and see how symptoms are progressing. A good clinical assessment will likely negate any need for imaging, but if it’s not behaving as we would expect, then an ultrasound or MRI can be worth pursuing if the conditions are right ¹ .

“If the individual has felt a big rip, or a pop at the time of injury and can’t walk pain free until day 10,

then that’s a 6-8 week injury before you scan it”

How long is it going to take?

It is important to appreciate that many factors influence the time required to successfully return to play from a calf muscle strain injury. At baseline (ie. when the injury has just occurred) the physiotherapist will use the information gathered about injury circumstances, functional ability, and imaging (if required) to determine the location and grade of the injury ^1,3,6,7 .

Grading of muscle injuries can assist with early prognosis and time frames to return to normal activities and sports. This is just a guide though, as many factors can influence whether the athlete can return at a particular period, including exposure to appropriate training loads and volumes, post-training symptoms, number and type of previous injuries, type of sport and position in team, and athlete confidence in the muscle ^1,3,6,7 .

A staged approach to managing calf strain is the most appropriate in determining prognosis ¹ . The value in staging is three-fold:

It reduces the risk of recurrence due to overly aggressive rehabilitation or premature return to play ^1,6 .
It avoids overly conservative return to play time frames.
It allows for performance-related factors to be considered and planned for throughout the recovery period.

You can check out the process we go through to determine injury prognosis here .

Injury management and return to play

“The most important thing is getting therapeutic loading started as soon as possible”

Best practice will utilise functional progression milestones to guide injury management and return to play. Why? Because people heal and recover at different rates. We’ve seen small grade 1 calf tears take 8 weeks to return to sport, while large tears demonstrated on MRI have successfully returned to play in less than 6 weeks.

We strongly advocate the Optimal Management Model as described in Green et al (2022) which considers:

Early injury assessment and management, including education, prevention of further damage, effective therapeutic loading, and normalising walking pattern.
Clinical and functional progression through the early to intermediate phases of rehabilitation, including reduction of signs and symptoms, progression of local strengthening, and addressing identified risk factors.
Shift from the medical to performance model, which involves reintegrating to full training, prioritising sports related capacities, and achieving effective balance between on-field and off-field activities.
Post return to play phase where risk factors continue to be mitigated and capacity is further developed to reduce re-injury risk.

For the calf muscle this means:

Early pain-free loading using theraband, modified weightbearing activities and isometric exercises.
Progressive foundation exercises such as directional calf strength, balance, multi-planar motion, and foot intrinsic muscles.
Directional work such as resisted step-ups, side steps and propulsion activities.
Locomotive reconditioning such as walking lunges, stairs, resisted bounding and sled pushes.
Power and ballistic exercises like hopping, jumping, resisted push off, and multi-directional box jumps.
Advanced running drills and plyometric activities.

The Take Home

Calf muscle injuries can be complex to manage and have a high rate of reinjury. The only way to manage a calf strain injury successfully is through a comprehensive assessment, treatment and return to sport plan. The Optimal Management Model when applied diligently and appropriately provides the best chance of successful return to play while mitigating the risk of re-injury. It will take time, dedication, and effort, but that calf injury will recover and a successful return to sport achieved.

Got a calf muscle strain injury and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your calf pain and let you know whether you have torn your gastroc or soleus, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Green et al (2022). The assessment, management, and prevention of calf muscle strain injuries: A qualitative study of the practices and perspectives of 20 expert sports clinicians. Sports Medicine, 8(10).
Green et al (2020). Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation. Scandinavian journal of medicine & science in sports, 30(1), 174-184.
Green et al (2019). Which factors are predictive of return to play and re-injury following calf muscle strain injury? Journal of Science and Medicine in Sport, 22, S19.
Green B and Pizzari T (2017) Calf muscle strain injuries in sport: A systematic review of risk factors for injury. British Journal of Sports Medicine, 51, 1189-1194.
Ishoi et al (2019). Diagnosis, prevention, and treatment of common lower extremity muscle injuries in sport – grading evidence: A statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). British Journal of Sports Medicine, 54, 528-539.
Meek et al (2022). Calf strain in athletes. Journal of Bone and joint Surgery, 10(3).
Orchard et al (2020). Fifteen-week window for recurrent muscle strains in football: a prospective cohort of 3600 muscle strains over 23 years in professional Australian rules football. British Journal of Sports Medicine, 54(18), 1103-1107.

Heel Pain - Achilles Tendon Tear

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 16 May 2023 11:00:32 GMT

Achilles tendon ruptures are complex and need skilled management.

Few musculoskeletal injuries are quite as acutely incapacitating and devastating as a rupture of the Achilles tendon. Capable of withstanding up to eight times our body weight in force, the Achilles tendon (AT) is the largest and strongest tendon in the human body. But it is not infallible. Ruptures occur when the load bearing capacity of the tendon is exceeded, resulting in tendon failure, significant pain, and loss of function.

A little bit of anatomy

The Achilles tendon is a thick, strong band of connective tissue that connects the calf muscles (the gastrocnemius and soleus) to the heel bone . It is the largest and strongest tendon in the body and is responsible for transmitting forces generated by the calf muscles to the foot and ankle, allowing us to walk, run, jump, and stand on tiptoes.

An Achilles tendon rupture is a complete or partial tear of the tendon that results from sudden or excessive force, such as during a rapid change of direction, jumping, or pushing off forcefully to start a sprint. In the presence of tendon overuse or degeneration, as occurs in older populations, the force required to rupture the tendon may be much lower.

When an Achilles tendon rupture occurs, the collagen fibers in the tendon tear, causing a loss of continuity between the calf muscles and the heel bone. This can result in pain, swelling, bruising, and difficulty with walking or standing on tiptoe. In severe cases, the rupture may be visible and palpable as a gap in the tendon.

Risk factors for Achilles tendon tears

The risk factors for Achilles tendon rupture are multi-factorial. While it can occur in people of all ages and activity levels, AT tears are more common in men and typically affect individuals who engage in sports or physical activities that require a lot of jumping and sudden changes in direction. Incidence of injury has increased in 30 years due to higher athletic and ageing populations.

Acute ruptures account for 68% of injuries and are more common in sports people where high levels of

stress are placed on the tendon - sports such as badminton, soccer, volleyball, basketball, tennis and squash.

Other risk factors for Achilles tendon rupture include obesity, smoking, comorbidities such as rheumatoid arthritis and systemic lupus erythematosus, and the use of some commonly prescribed medications such as fluoroquinolone and steroids. Poor running mechanics and altered biomechanics such as high arch, flat foot, and leg length discrepancy can increase the risk of injury.

Diagnosing Achilles Tendon Rupture

The signs and symptoms of an Achilles tendon rupture can vary depending on the severity of the injury. Most people report sudden and severe pain in the back of the ankle or calf, like they have been struck by a stone. This pain can feel like a sharp or stabbing sensation and may be accompanied by a popping or snapping sound.

In most instances people have trouble walking or standing on tiptoe. This may be accompanied by an inability to plantarflex (point) the foot and some restriction in ankle range of movement. Swelling and bruising can develop quickly and be accompanied by ankle stiffness and pain.

There are some special tests that the physiotherapist can perform to help rule in or rule out an Achilles tendon rupture. A thorough physical examination will consider other possible conditions that can cause similar symptoms to a tendon injury such as:

Calf muscle strain or rupture
Ankle Sprain
Achilles Tendinopathy
Lower leg fracture
Deep Vein Thrombosis (DVT)
Nerve injury
Plantaris tendon rupture

Do I need a scan?

Qualified health care professionals including physiotherapists can normally diagnose an Achilles tendon rupture clinically, without the need for further investigations. In some cases, particularly if a partial tear is suspected, or if surgery is being considered, ultrasound and/or MRI can prove beneficial in the management of an Achilles injury. Your physiotherapist can help you to make an informed decision on the need for a scan.

Management of Achilles Tendon Rupture

The management of Achilles tendon rupture depends on the severity of the injury, the age of the patient, co-morbidities, and individual objectives such as a desire to return to sport.

Both non-surgical and surgical options are applicable with an Achilles tendon rupture.

Surgery has been shown to reduce the risk of a re-injury but carries with it an increased cost and increased risk of scar adhesions, loss of sensation, deep vein thrombosis (DVT), and infection. Surgery may be recommended for more severe injury or for patients who are physically active and require a quicker return to activities. Surgery involves reattaching the torn ends of the tendon, often using sutures or anchors, and may require a period of immobilization followed by intensive physiotherapy.

Non-surgical treatment options may include immobilization of the affected leg in a cast or walking boot, physiotherapy, and anti-inflammatory medications to reduce pain and swelling. This option has been shown to have similar outcomes in the long term particularly when coupled with accelerated functional rehabilitation.

Regardless of the treatment approach, rehabilitation and physiotherapy are essential for a successful recovery from an Achilles tendon rupture. Physiotherapy typically focuses on:

Reducing residual pain and swelling
Restoring ankle dorsiflexion while protecting the healing tissue
Strengthening the calf and Achilles tendon
Improving the strength and coordination of the lower limb
Providing a safe and competitive return to sport

How long’s it going to take?

The recovery time for an Achilles tendon rupture can vary depending on the severity of the injury and the treatment approach. Treated conservatively (ie. non-surgically), management usually involves immobilization in an equinas cast or walking boot for 6-12 weeks, with a further 6-12 weeks required to achieve return to sport (so around 5-6 months from date of injury).

Managed surgically, the patient will still require a walking boot that is gradually adjusted to allow stretch to be applied to the healing tendon. This is generally required for at least 6 weeks followed by 8-12 weeks of rehabilitation to achieve return to sport (so around 4 months).

It is important to note that every person is different and may have unique circumstances that can affect the recovery timeline. Factors that can impact recovery time include age, overall health, and the severity of the injury. Additionally, following a rehabilitation program and adhering to a health professional such as physiotherapist recommendations for activity restrictions and exercise can help ensure the best possible outcome and reduce the risk of reinjury.

The Take Home

Achilles Tendon rupture is a common injury that can result in pain, weakness, and affect activities of daily living and sport. Diagnosis can be made by a physiotherapist, and treatment guided dependent on the individual person’s injury severity, age, co-morbidities and personal goals. Throughout the rehabilitation journey for an Achilles tendon rupture, physiotherapy is a key component of your recovery and return to work, sport and daily activities.

Got an Achilles tendon problem and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your heel pain and let you know whether you have torn your Achilles, have a bursitis or tendinopathy, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Aujla, R., Patel, S., Jones, A., Bhatia, M. Non-operative functional treatment for acute Achilles tendon ruptures: The Leicester Achilles Management Protocol (LAMP). Injury. (2019), 50(4), 995-999. https://doi.org/10.1016/j.injury.2019.03.007
Maffuli, N., Peretti, G. M. (2019). Surgery or conservative management for Achilles tendon rupture? TheBMJ;364:k5344 doi: 10.1136/bmj.k5344
Massen, F. K., Shoap, S., Vosseller, J. T., Fan, W., Usseglio, J., Boecker, W., ... & Polzer, H. (2022). Rehabilitation following operative treatment of acute Achilles tendon ruptures: a systematic review and meta-analysis. EFORT Open Reviews, 7(10), 680.
Strom, A. C., & Casillas, M. M. (2009). Achilles tendon rehabilitation. Foot and ankle clinics, 14(4), 773-782.
Tarantino D, Palermi S, Sirico F, Corrado B. Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. Journal of Functional Morphology and Kinesiology. 2020; 5(4):95. https://doi.org/10.3390/jfmk5040095
Touzell, A. (2020). The Achilles tendon: Management of acute and chronic conditions, Australian Journal of General Practice. 49(11). doi: 10.31128/AJGP-07-20-5506
Utashima, D., Matsumura,N., Suzuki, T., Iwamoto, T., Ogawa, K. Clinical Results of Surgical Resection and Histopathological Evaluation of Synovial Chondromatosis in the Shoulder: A Retrospective Study and Literature Review. (2020). Clinics in Orthopedic Surgery. 12:68-75. https://doi.org/10.4055/cios.2020.12.1.68

Concussion - Recognise the Symptoms

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 11 May 2023 08:37:19 GMT

Could you recognise the symptoms of concussion on Saturday morning?

How well do you know concussion? Could you recognise the signs and make an informed decision about the welfare of a player who may have a concussion on Saturday morning? Do you know your 5Rs when it comes to concussion ?

While concussion might seem like a hot topic right now, in the sports medicine field, concussion has been a big issue for a long time.

As an injury with potential long-term repercussions, concussion is finally getting the recognition it deserves. But the bridge to recognising and managing concussion amongst our most vulnerable – our kids – and in amateur sport, has a long way to go. Fortunately, there is a growing body of evidence, websites, and user-friendly apps to help navigate the concussion world. (There’s a list at the bottom of this blog).

What is a concussion?

The 5 ^th International Conference on Concussion in Sport held in Berlin in 2016 defines sport-related concussion as:

“…a traumatic brain injury induced by biomechanical forces.”

It can be a direct or indirect force to the head, face, neck or elsewhere with the force transmitted to the head. The force imparted to the head can cause a biochemical imbalance within the brain cells, resulting in a disturbance in brain function rather than a structural injury to the brain.

Concussion is common in the contact sports many Australians participate in across the country and while we might immediately think AFL, boxing, and rugby codes, non-contact sports such as cycling, basketball, soccer, hockey, and netball have their fair share of head knocks that result in concussion. Early identification of a sports related concussion is important for treatment and ongoing management of athletes.

Signs and Symptoms

When we’re around sport, we need to be looking out for signs and symptoms of a sports related concussion; signs are changes that are observed by others; and symptoms are felt and reported by the patient.

Signs observed by others include:

Appearing dazed/stunned
Moving clumsily
Confused about their position, sports plays, scores, or be disoriented to place and time
Answering questions slowly/delayed
Demonstrating behavioural or personality changes
Being unable to recall events prior or after fall/hit

Symptoms reported by the patient include:

Headache/pressure in head
Nausea/vomiting
Balance/dizziness problems
Sensitivity to light and noise
Feeling sluggish/foggy/ hazy/groggy
Reduced concentration/memory
Confusion
They just don’t feel right

Red Flags

Every suspected incident of concussion should be treated seriously, however certain red flags identify those athletes that should be immediately evaluated by a doctor or licensed healthcare professional.

Red flags may include:

Neck pain or tenderness
Increasing confusion and irritability
Repeated vomiting
Seizure or convulsion
Weakness or tingling/burning in arms or legs
Loss of consciousness
Deteriorating conscious state
Severe or increasing headache
Double vision

After assessment the doctor or licensed healthcare professional may at their discretion send the athlete for further assessment at a medical facility.

How can sporting organisations help recognise concussion?

Prevention, recognition, and management of concussion within sport is everyone’s responsibility

Sports Medicine Australia recommend the following approach for sporting teams and organisations:

Educate. Educate personnal - players, parents, coaches, umpires, managers, and other people associated with the team - about recognising the signs and symptoms of concussion. These can be done through both fact sheets provided at preseason as well as face-to-face education.
Information. In the pre-season period, gather information on all players about their concussion history and identify those players who are at higher risk of a concussion.
Designate. It is recommended that clubs and/or teams have a designated concussion coordinator that has the authority to make decisions and be proactive around concussion. Coordinators will update all stakeholders on concussion policy, notify parents of concussed junior players and ensure concussion protocols are followed.
Get an app. Apps such as headcheck or the Sport Concussion Assessment Tool 5 (SCAT5) are free, easy to apply and can assist in identifying a concussion and guiding the next step in management.

How can I help?

The days of brushing off a head knock as a badge of honour or as “character building” are well past us. Our knowledge and understanding has advanced significantly in the past 20 years and so too should our management and preparedness to report concussion.

If you're a player:

Treat it seriously.
Report concussion symptoms, even if they are mild.
Report if you suspect a teammate has a concussion, even if their symptoms are mild.
Follow any medical advice provided.

If you're a parent/guardian:

Learn the 5Rs of concussion .
Talk to your kids, ask about the game and discuss any head knocks that they report.
Watch carefully for immediate and delayed signs and symptoms of concussion.
Seek proper care for your child and follow medical advice.
Inform stakeholders such as the coach, sports trainers, physiotherapist, or concussion coordinator of your child’s health and any medical advice received.

The Take Home

Concussion is a common risk of many sports. It's potential long-term ramifications demand greater understanding and acceptance by participants and sports personnal. Understanding and recognising the signs and symptoms of concussion is imperative if the long-term effects of sports-related concussion are to be effectively managed and the enjoyment of sport preserved.

If your looking for some more information on the management of concussion, check out the following links:

Have you recently had a concussion and want to get it sorted? Give us a call.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Resources:

Daly, E., Pearce, A. J., Finnegan, E., Cooney, C., McDonagh, M., Scully, G., ... & Ryan, L. (2022). An assessment of current concussion identification and diagnosis methods in sports settings: a systematic review. BMC sports science, medicine and rehabilitation, 14(1), 1-10.
Schneider, K. J., Patricios, J., Echemendia, R. J., Makdissi, M., Davis, G. A., Ahmed, O. H., ... & Engebretsen, L. (2022). Concussion in sport: the consensus process continues. British journal of sports medicine, 56(19), 1059-1060.
Yeo, P. C., Yeo, E. Q., Probert, J., Sim, S. H., & Sirisena, D. (2020). A systematic review and qualitative analysis of concussion knowledge amongst sports coaches and match officials. Journal of Sports Science & Medicine, 19(1), 65.

Cervical Spondylosis

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 03 May 2023 05:40:42 GMT

It's wear and tear in the neck, that responds well to a Physio!

Neck pain can be, well, a right pain in the neck! The neck is a super mobile structure, but this does make it prone to arthritic change, something the medical professionals refer to as cervical (serr-vick-el, meaning neck) spondylosis (spon-duh-low-suhs, meaning wear and tear).

Cervical Spondylosis occurs naturally as an age-related process associated with changes within the intervertebral (IV) discs.

Frequently, Cervical Spondylosis presents as pain localized to the neck and continues to be a leading cause of disability. Physiotherapy within an interprofessional team is key in the evaluation and management of Cervical Spondylosis.

Anatomy 101

The cervical spine is made up of 7 distinct vertebrae (bones). The first two bones of the cervical spine are unique in themselves. The first cervical vertebrae (C1) is known as the atlas (for all of the Greek Mythology enthusiasts out there it is thought that the first cervical vertebrae is given this name because it holds up the globe of the cranium the way Atlas holds up the globe of the heavens). The second vertebrae (C2) is known as the axis. Together C1 and C2 allow for up to 30% of the rotation performed in the neck.

The main function of the cervical spine is to support and cushion loads to the head and neck whilst allowing for rotation, and protecting the spinal cord as it extends from the brain.

Between each vertebrae sits an intervertebral disc with two facet joints either side that connect the bones together. Plenty of ligaments surround these structures to provide stability whilst ensuring enough mobility is available. Muscles in this area that control and move the head and neck include the suboccipitals, upper trapezius, sternocleidomastod, scalenes and many more.

Who gets it?

Pretty much everyone! Most people who present with Cervical Spondylosis are over the age of 40, with up to 86% of people experiencing pain and dysfunction associated with cervical spondylosis at some point in their life time. Risk factors include previous injury or trauma to the neck, playing contact sports such as football or rugby, and congenital conditions such as cerebral palsy which affects the muscles of the neck.

Diagnosing Cervical Spondylosis

Common signs and symptoms of Cervical Spondylosis include stiffness and pain in the neck (more severe in upright positions and relieved with laying down), pain on hyperextension (looking up to the sky) or side bending through the neck, as well as pain on palpating or putting pressure along areas of the neck. Referred pain to areas such as the back of the head (occiput), between the shoulder blades, or down the arm can be a sign of Cervical Spondylosis. Less frequently people can experience dizziness, vertigo and poor balance.

Cervical Spondylosis may be paired with other conditions such as cervical radiculopathy. This would likely present with neurological symptoms such as pins and needles and numbness of the upper limb as well as weakness or clumsiness of the hands. Other common conditions that present with similar symptoms include cervical sprain, myofascial pain, and cervical fracture.

A thorough physical examination is required to diagnose Cervical Spondylosis and exclude other possible causes. Common tests include assessing active and passive range of movement of the neck, mid-back and upper limbs, specific joint tests, and palpation of the cervical spine and surrounding musculature. Where indicated, physiotherapists will perform a neurological examination testing upper limb sensation, reflexes, and an assessment of strength.

Do I need a scan?

Patients with Cervical Spondylosis do not usually require further investigations, as the diagnosis can be made on clinical examination alone. X-rays may show features of degenerative disease however these findings can also be found in people without any symptoms. Thus, x-rays can correlate poorly with clinical symptoms. If more serious conditions are suspected, then an MRI is the investigation of choice.

Treatment

Physiotherapy plays an important role in the management of patients with Cervical Spondylosis.

A study by Alsan & Karaduman (2012) found that pain and function in clients that received physiotherapy had significant improvements both in the short and long term, whereas those that were treated with medications alone did not show significant long-term improvements.

Physiotherapy treatment usually follows a general course of manual therapy in the acute phase where pain and stiffness are the main symptoms. Massage, mobilizations, dry needling, traction, and passive stretches are some of the techniques known to be effective. These techniques are paired with education and a home exercise program designed to normalize movement and achieve long term improvements.

Active therapy is key to managing Cervical Spondylosis. Graded exercises to improve posture, reduce the tone of overactive muscles and improve motor control of underactive muscles have been shown to reduce pain, increase neck range of movement and improve overall quality of life.

Other therapy that may complement physiotherapy include remedial massage, general exercise, and medications (discuss with your GP or local pharmacist).

How long’s it going to take?

Generally Cervical Spondylosis is a condition that comes on over a long time, and with many contributing factors it can be a condition that needs to be ‘managed’ rather than ‘cured’. Acute flare ups can be treated and managed generally within 4-6 weeks. However, more severe and chronic cases should see gradual improvement over 3-6 months and sustained functional improvements with lifestyle adaptations including changes to posture and maintaining an active lifestyle.

The Take Home

Cervical Spondylosis is an age-related process that occurs naturally over a lifetime. Due to various lifestyle factors, the onset of Cervical Spondylosis and severity of the condition can be different for each person. Physiotherapy plays a key role in assessing, diagnosing and managing neck pain, including cervical spondylosis. Manual therapy, education and graded therapeutic exercise guided by a physiotherapist will see you back doing the things you enjoy sooner, ensuring you keep living a healthy and active life.

If your looking for some more information on the management of acute neck pain, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you have a painful neck and want to get it sorted? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons and can treat and manage your neck pain with a personalised, goal-oriented and comprehensive management plan.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Resources:

Aslan Telci, E., Karaduman, A. (2012) Effects of three different conservative treatments on pain, disability, quality of life, and mood in patients with cervical spondylosis. Rheumatol Int 32, 1033–1040
Binder, A. I. (2007). Cervical spondylosis and neck pain. BMJ, 334(7592), 527-531.
Brukner, P., & Khan, K. (2012). Clinical Sports Medicine, 4th EditionFakhoury, J., & Dowling, T. J. (2020). Cervical degenerative disc disease.
Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care. J Orthop Sports Phys Ther 2017;47(7):513. doi:10.2519/jospt.2017.0508
Neck Pain: Dry Needling Can Decrease Pain and Increase Motion. J Orthop Sports Phys Ther 2014;44(4):261. doi:10.2519/jospt.2014.0502
Khan, J. A., & Pandey, V. K. (2020). Evidence-Based Diagnosis and Physiotherapy Management of Musculoskeletal Disorders of Cervical Spine.
Theodore, N. (2020). Degenerative Cervical Spondylosis. The New England Journal of Medicine, vol. 383, no. 2, pp159 – 168.

Deep Tissue Massage

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 24 Apr 2023 05:53:32 GMT

Muscle tightness or pain you can't quite reach? A deep tissue massage might help.

Ever had that niggling tightness in a muscle that you just can’t seem to stretch? Or neck pain that just won’t subside? Deep tissue massage (DTM) can be an effective adjunct treatment to help manage a range of musculoskeletal presentations and is a go treatment for athletes (both recreational and elite) and non-athletic populations world-wide.

What is Deep Tissue Massage?

The human body is super cool, with layers of muscle found from just under the skin, right down to the joint edges. Some of these muscles are superficial and easy to get to, while others are deep, hidden under layers of fascia, adipose tissue, and other large muscles.

For these deep muscles, DTM is an excellent treatment option.

DTM therapy is a remedial massage technique that targets the deeper layers of muscles and connective tissue within the body to alleviate pain and discomfort. It involves the repeated use of slow, deep strokes and firm pressure to relax the superficial layers of tissue and allow the therapist to reach the deeper layers of muscle and fascia. Through these techniques trigger points can be released, muscles relaxed, and mobility improved.

How will it help?

The benefits of deep tissue massage therapy are numerous. Like other forms of massage, it helps the mind and body to relax, can help alleviate chronic pain, improve blood and fluid circulation, reduce stress and anxiety, and promote muscle recovery after exercise.

Further to this:

In people with non-specific neck pain, deep tissue massage combined with exercise therapy has been shown to be effective in the short term, and superior to a wait-and-see approach.
Studies have demonstrated that deep tissue massage is effective at reducing pain associated with myofascial pain syndrome, with participants reporting statistically significant improvements in reported pain and quality of life questionnaires.
In cancer survivors experiencing sleep disturbance after treatment, massage has been shown to improve sleep patterns.

Anecdotally DTM is found to promote joint mobility and flexibility.

It can aid in the recovery of injuries such as muscle strains and tendon injuries by reducing scar tissue formation, promote localized blood circulation, and stimulate appropriate tissue formation.

What to expect.

Deep tissue massage therapy is a remedial massage technique so expect the therapist to use a variety of techniques such as:

Myofascial release. This involves sustained pressure being applied to tight bundles of muscle fibers until the bundle “releases” and reverts to its relaxed state.
Stripping. This involves applying firm pressure along the length of the muscle fibers, often with the muscle in a stretch position or with the person actively contracting the muscle at the same time.
Frictions. Transverse friction involves applying a back-and-forth pressure perpendicular to the orientation of the muscle fibers, while circular friction involves applying small circular movements to muscle fibers.

The therapist may use their fingers, knuckles, elbows, or even specialized tools to release deeper layers of muscle tissue. Because the tissues are deep, this type of massage can be a little uncomfortable and, in some instances, result in light bruising. Communicate with your therapist during the session to make sure the pressure applied is right for you.

How to get the most from your Deep Tissue Massage.

Communicating with your therapist about why you are seeking massage and what your goals are from massage are a crucial first step to ensuring a good outcome from treatment. A good massage therapist will know where to go, but constant communication and feedback will ensure the best results.

After a deep tissue massage therapy session, it is crucial to engage in some self-management strategies.

Your massage therapist will be able to advise you on these, including drinking plenty of water, avoiding strenuous exercise for a short period of time, and using heat packs or hot showers. These strategies can assist with the removal of byproducts from the muscles, ease soreness associated with the massage and allow the muscles to recover. Stretching and gentle exercises can help maintain muscle flexibility and prevent muscle stiffness recurring.

Who is Deep Tissue Massage for?

Deep tissue massage therapy is not for everyone. Persons with underlying health conditions such as osteoporosis, cancer, or blood clots should avoid DTM, while certain chronic pain presentations may have adverse outcomes to DTM.

It is essential that clients discuss their underlying health conditions with the

treating therapist prior to consenting to treatment.

If you are uncertain if deep tissue massage is appropriate for you, consult with your physiotherapist or GP prior to attending a massage appointment.

The Take Home

Deep tissue massage therapy is an effective form of treatment for those who suffer a range of musculoskeletal conditions, chronic pain, sleep disturbance, stress, and anxiety. It provides numerous physical and mental health benefits, including reducing inflammation, promoting healing, and improving overall physical and mental well-being. By combining with therapeutic exercise and some simple self-management strategies, clients can maximize the benefits of deep tissue massage therapy and maintain long-term improved general health and well-being.

If you're looking for a Massage Therapist, then give us a call.

We have a fully qualified, experienced soft tissue massage therapist on staff who works closely

with our physiotherapists to help achieve optimal outcomes.

Give us a call on 08 8945 3799 or Book Online now.

Sources.

Bingölbali, Ö., Taşkaya, C., Alkan, H., & Altındağ, Ö. (2023). The effectiveness of deep tissue massage on pain, trigger point, disability, range of motion and quality of life in individuals with myofascial pain syndrome. Somatosensory & Motor Research, 1-7.
Majchrzycki, M., Kocur, P., & Kotwicki, T. (2014). Deep tissue massage and nonsteroidal anti-inflammatory drugs for low back pain: a prospective randomized trial. The Scientific World Journal, 2014.
Romanowski, M. W., & Spiritovic, M. (2016). Deep tissue massage and its effect on low back pain and functional capacity of pregnant Women-a case study. Journal of Novel Physiotherapies, 6(03).
Romanowski, M., Romanowska, J., & Grześkowiak, M. (2012). A comparison of the effects of deep tissue massage and therapeutic massage on chronic low back pain. Studies in health technology and informatics, 176, 411–414.
Samuel, S. R., Gururaj, R., Kumar, K. V., Vira, P., Saxena, P. P., & Keogh, J. W. L. (2021). Randomized control trial evidence for the benefits of massage and relaxation therapy on sleep in cancer survivors—a systematic review. Journal of Cancer Survivorship, 15, 799-810.
Skillgate, E., Pico-Espinosa, O. J., Côté, P., Jensen, I., Viklund, P., Bottai, M., & Holm, L. W. (2020). Effectiveness of deep tissue massage therapy, and supervised strengthening and stretching exercises for subacute or persistent disabling neck pain. The Stockholm Neck (STONE) randomized controlled trial. Musculoskeletal Science and Practice, 45, 102070.

The Shoulder - Labral Injuries

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 06 Apr 2023 07:10:44 GMT

Labral injuries are complex to diagnose and impact shoulder stability.

The shoulder is an inherently unstable structure, reliant on the dynamic control of the rotator cuff muscles and a ring of fibrocartilage called the labrum to provide depth to the socket and functional stability.

Injury to these structures can have a devastating effect for an individual.

The labrum helps to stabilize the shoulder joint and keep the ball of the upper arm bone securely located by deepening the socket. Damage to the labrum can occur either from a traumatic injury, such as a fall or an accident, or from repetitive overhead motions that place stress on the shoulder joint, such as those common in sports like baseball or tennis, disrupting the stability of the shoulder and resulting in pain and instability.

A little bit of anatomy

The shoulder labrum is a ring of cartilage that surrounds the glenoid cavity of the scapula (shoulder blade). It effectively deepens the socket where the head of the upper arm bone (humerus) meets the shoulder joint. The labrum serves as a stabilizing structure for the shoulder joint and helps to keep the head of the humerus securely in place. It is well supported by numerous ligaments, and the rotator cuff , a group of muscles that surround the shoulder joint and provide dynamic stabilization.

The labrum is composed of fibrocartilage, a type of connective tissue that is both strong and flexible. It has a tough, rubbery texture and is thicker at the top than at the bottom. The labrum is attached to the rim of the glenoid cavity, providing an anchor for the tendons and ligaments that surround the shoulder joint. Together with the rotator cuff muscles, the labrum forms an integral part of normal shoulder function.

Risk factors and injury prevention

Shoulder labral tears occur in a wide range of individuals across the lifespan, including athletes and non-athletes. Some groups of people are more prone to this type of injury than others though.

Athletes who participate in activities that involve repetitive overhead motion, such as baseball, cricket, swimming, volleyball, and tennis, are at a higher risk of developing labral tears, as are athletes involved in contact sports like AFL, rugby, and martial arts.

Acute labral tears are more common in younger men than in women largely due to their increased exposure to load in contact sports and through gym programs, though this is changing as more females take up contact sports. Strength programs that load the pectorals and biceps (the mirror muscles) are often implicated in acute labral injuries.

The prevalence of chronic labral tears increases with age due to natural degeneration of the shoulder joint over time. Chronic tears are strongly correlated with a history of shoulder dislocation or subluxation (shoulder instability) and a history of previous shoulder injuries.

The most common type of labral injury is called a SLAP lesion. This results from overload of the biceps tendon, which pulls the superior part of the labrum away in an anterior to posterior manner, thus the acronym SLAP (Superior Labrum Anterior Posterior). These tears account for approximately 1% to 3% of all injuries presenting to sports medicine referral centers and are identified in approximately 6% of all shoulder arthroscopy procedures performed.

Diagnosing Labral Injuries

Diagnosing labral tears of the shoulder is challenging due to the complex anatomy of the labrum, the variable symptoms people present with, and the likelihood of co-existing problems at the shoulder joint.

A thorough interview and physical assessment is crucial to the process. Understanding your previous and current shoulder use, sporting background, previous injury history and current symptoms will help paint a picture of what is going on in your shoulder.

Signs and symptoms of a labral tear can vary but often include pain, instability, clicking and/or popping, reduced range of movement, and reduced strength. Many people will often report a fear of certain movements or actions as the shoulder feels like it will pop out. If you are experiencing these symptoms, see you physiotherapist and get your shoulder assessed. They will be able to perform a range of special clinical tests on the shoulder and differentiate between injury to the labrum and other conditions such as a rotator cuff injury, subluxation , bursitis, frozen shoulder and arthritis .

Do I need a scan?

A labral tear can be challenging to diagnose during a clinical examination and further investigations are often valuable to determine the location and extent of injury. MRI is the gold standard, though an arthrogram (where contrast fluid is injected directly into the shoulder joint just prior to the MRI being performed) is often required to specifically diagnose injuries in the joint structures that an MRI alone would likely miss.

Evidence suggest that MRI documented SLAP lesions can be present in up to 72% of middle-aged, asymptomatic patients.

Treat the symptoms, not the scan. It is important to recognize that other shoulder pathologies, such as shoulder impingement (external or internal), rotator cuff syndrome, biceps tendinopathy, and acromioclavicular (AC) arthritis, are all common pain generators in the middle-age population. Thus, the focus could be either over appreciated or misdirected. In 2005, an MRI analysis of professional handball players demonstrated abnormalities in 93% of shoulders, whilst only 37% of these players had symptoms.

Management of Shoulder Labral Injuries

The best course of treatment for a shoulder labral tear is dependent on the severity of the tear, the patient’s age and activity level, and other individual factors. Most people will be referred to an orthopaedic surgeon so that consideration can be given to surgical intervention. Given the prevalence of labral tears in both non-symptomatic populations and in older persons, a period of conservative management can be worthwhile prior to progressing to surgical repair. A multi-disciplinary client-centered approach to management can help with these decisions.

There is good quality evidence to show the value of physiotherapy in managing labral injury both conservatively and in the post-surgical period.

In the acute phase, load management and activity modification are crucial to allow pain and inflammation to settle. Soft tissue techniques, dry needling , manual therapy, and taping techniques can all assist in managing pain and improving shoulder movement.

Functional strengthening of the shoulder blade and shoulder joint are the foundation of a successful rehabilitation program for shoulder labral injury. A customized exercise program will ensure that the functional requirements of the individual are at the forefront of the rehabilitation process. Strengthening must be approached in a gradual manner, with a strong focus on improving shoulder blade biomechanics before embarking on return to sport and work activities.

How long’s it going to take?

The recovery time for a shoulder labral tear can vary widely depending on the severity of the tear, the individual’s age and overall health, and the type of treatment they receive.

If the tear is small and does not require surgery, recovery time can range from a few weeks to a few months. During this time, the individual may need to avoid certain activities that put stress on the shoulder, undergo regular physiotherapy, and, where indicated, take pain medications or anti-inflammatory drugs as prescribed by a healthcare professional.

If surgery is required, the recovery time can be longer, typically ranging from four to six months. The individual may need to wear a sling for several weeks after surgery and undergo a period of immobilization and rehabilitation.

The Take Home

Shoulder labral tear is a common injury that can result in pain, weakness, and instability in the shoulder joint. Treatment options will vary depending on the severity of the injury, the age and goals of the individual, and the degree of shoulder instability present. Throughout the rehabilitation journey for a labral injury, physiotherapy is a key component of your recovery and return to work, sport and daily activities.

Got shoulder pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shoulder pain and let you know whether you have injured your labrum, torn your rotator cuff muscles, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Call us now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Sources

Arirachakaran, A., Boonard, M., Chaijenkij, K. et al. (2017). A systematic review and meta-analysis of diagnostic test of MRA versus MRI for detection superior labrum anterior to posterior lesions type II–VII. Skeletal Radiol 46, 149–160. https://doi.org/10.1007/s00256-016-2525-1
Bianco, L. (2022). Conservative Care of a Patient with Initial Anterior Shoulder Dislocation Participating in an Intercollegiate Basketball: A Case Study. Clinical Practice in Athletic Training, 5(1).
Carbone, A., Limpisvasti, O. (2022). Understanding Batter’s Shoulder: Diagnosis, Treatment, and Outcomes. Curr Rev Musculoskelet Med 15, 547–551. https://doi.org/10.1007/s12178-022-09795-y
Frangiamore, S., Maier, J., & Schickendantz, M. (2021). SLAP tears in the throwing shoulder: a review of the current concepts in management and outcomes. Operative Techniques in Sports Medicine, 29(1), 150798.
Panayiotou Charalambous, C. (2019). Superior Labrum Tears of the Shoulder. In: The Shoulder Made Easy . Springer, Cham. https://doi.org/10.1007/978-3-319-98908-2_27
Touri, A. (2019). Treatment Of A Work-Related Superior Glenoid Labral Repair: A Case Report. Case Report Papers. 107. https://dune.une.edu/pt_studcrpaper/107
Van Blarcum, G. S., & Svoboda, S. J. (2017). Glenohumeral instability related to special conditions: SLAP tears, pan-labral tears, and multidirectional instability. Sports Medicine and Arthroscopy Review, 25(3), e12-e17.
Varacallo M, Tapscott DC, Mair SD. (2023). Superior Labrum Anterior Posterior Lesions. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538284/

Heel Pain - Achilles Tendinopathy

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 29 Mar 2023 06:31:57 GMT

Treat this heel problem early to avoid a world of (Achilles) pain.

Achilles (uh-ki-leez) tendinopathy is a painful overuse condition affecting the Achilles tendon that is extremely common in the general population and in athletes, particularly those participating in running and jumping sports.

Achilles tendinopathy is estimated to cause 32% of lower extremity injuries in runners.

It is characterised by gradual onset of localised pain and swelling, and a gradual loss of function. If symptoms are identified early, Achilles tendinopathy can be well managed, and time lost to sport and recreational activities minimised. If symptoms are ignored, recovery can be prolonged (greater than 12 months) and the risk of reinjury significantly increased.

A little bit of anatomy

The Achilles tendon is essential for many everyday activities, such as walking, running, jumping, and climbing stairs. Understanding the basic anatomy of the tendon can help to understand how it becomes injured, and why it is so important to function.

The Achilles tendon is the largest tendon in the body and can be easily palpated at the back of the heel . Located at the back of the ankle, it is formed by the merging of the calf muscles (gastrocnemius and soleus) and attaches to the heel bone (calcaneus). The tendon is approximately 15 centimetres long and is composed of tough, fibrous tissue that is capable of withstanding large forces. The fibres of the tendon are arranged in a parallel fashion, allowing the tendon to transmit forces from the calf muscles to the foot.

The Achilles tendon is surrounded by a protective sheath called the paratenon, which helps to reduce friction between the tendon and surrounding tissues during movement. The paratenon contains small blood vessels that provide nutrients to the tendon. Lower down near the heel, there are a couple of bursae which can be implicated in heel pain (Click here for info on retrocalcaneal bursitis).

What's in a name?

The term tendinopathy is preferred to tendonitis as it covers a broader range of presentations that may or may not include inflammation.

Achilles tendinopathy literally means pathology of the Achilles tendon and its cause can be classified as either compressive or tensile in nature. Compressive Achilles tendinopathy occurs near where the tendon inserts into the calcaneum or the heel. Here, the tendon is susceptible to compression against the underlying bone, which can be exacerbated in the presence of a Haglund deformity.

The ability to distinguish between a compressive and tensile presentation is crucial for successful rehabilitation.

Tensile Achilles tendinopathy is more likely in the mid and upper parts of the Achilles tendon. Here the tendon participates in energy storage and release via stretch-shortening cycles and is susceptible to overload by high repetition.

Risk factors and injury prevention

The risk for developing Achilles tendinopathy is considered multifactorial, with intrinsic and extrinsic risk factors contributing to symptoms, largely due to reducing the tolerance of the tendon to load or altering movement patterns that overload the tendon. Intrinsic risk factors include age (35-54 years old is the highest risk), sex (males have higher risk), body weight, systemic disease (such as diabetes and rheumatoid arthritis), and a history of smoking. Extrinsic factors include mostly sports and occupational related activities, as well as medications, footwear, training surfaces and training errors (particularly increased training load and intensity and/or reduced recovery time).

Recognising risk factors, educating people and taking preventative measures to reduce the risk of developing Achilles tendinopathy are key health strategies for health care providers. Screening athletes prior to competition can assist in identifying modifiable risk factors, while early intervention is crucial to limiting time lost to sport and recreation due to Achilles tendinopathy.

Diagnosing Achilles Tendinopathy

Diagnosing Achilles tendinopathy can be complex due to the number of conditions that can occur in this region and the similarities they share. A thorough interview regarding the nature of symptoms and how they developed, physical assessment and other tests are essential to identify or exclude other potential sources or reasons for symptoms.

Achilles tendinopathy will tend to start slowly, with a gradual increase in pain and stiffness. Initially symptoms will ‘warm up’ – that is they will improve with some activity. If not given time to recover though, symptoms will progress, and activity will be further impacted. Some of the more common signs and symptoms of Achilles tendinopathy include:

Pain and stiffness in the Achilles tendon, especially in the morning or after periods of inactivity.
Swelling and tenderness in the area around the Achilles tendon.
Thickening of the Achilles tendon.
A creaking or cracking sound when the ankle is moved.
Limited range of motion in the ankle.
Redness or warmth in the affected area.

In more severe cases, or if the condition has persisted for long periods, there may be a partial or complete Achilles tendon tear. This is generally accompanied by more severe pain, swelling and bruising, and may make it difficult to walk or stand. If you experience any of these symptoms, it's important to seek medical attention. Early treatment can help prevent further damage to the Achilles tendon and improve your chances of a full recovery.

Do I need a scan?

This will depend on the duration and severity of symptoms, and if treatment has been unsuccessful. X-ray can be helpful to identify a Haglund’s deformity and its relationship to insertional tendinopathy. Ultrasound and MRI can be beneficial to confirm the diagnosis of AT and the stage of disease respectively.

Management of Achilles Tendinopathy

Once a diagnosis of Achilles tendinopathy is established, the challenge is to work out what is happening in the tendon. Understanding the cause of the injury, the phase of the injury (particularly if the tendon is in a reactive or degenerative phase) and issues contributing to symptoms is challenging, and it is these factors that will determine the type and style of rehabilitation you need.

Activity modification is an important first line of treatment. Reducing exposure to aggravating factors (running, hills, certain shoes) is essential to managing Achilles tendinopathy.

Exercise therapy is considered the gold standard treatment in the management of Achilles tendinopathy long term and has the highest level of evidence for effect. The volume, load and type of exercise will be guided by many factors, including whether the issue is compressive or tensile in nature, the phase of the injury and co-existing biomechanical problems – think hip, knee, and ankle issues.

Manual therapy, soft tissue therapy and dry needling can be beneficial in the acute and sub-acute phases of Achilles tendinopathy in relieving pain and restoring ankle range of movement. These interventions are non-invasive or minimally invasive, cheap and have minimal side effects, and have good level of evidence for therapeutic use in the first 3-6 weeks.

Your doctor may prescribe oral non-steroidal anti-inflammatories for pain relief however they will not improve the condition as tendinopathy is a non-inflammatory condition. Your doctor or physiotherapist can discuss this with you, as well as general lifestyle modifications, as part of a multidisciplinary approach.

If your looking for some more information on the management of Achilles Tendinopathy, check out this perspective from the Journal of Orthopaedic Sports and Physical Therapy .

Other Treatments

Shockwave therapy, platelet-rich plasma injections and prolotherapy have all shown promising anecdotal outcomes in the management of Achilles tendinopathy however require significant further research to determine their effectiveness and value against other treatment options.

Corticosteroid injections have been shown to have no therapeutic benefit and have been identified as a risk factor for progression of Achilles tendinopathy to tendon rupture. They should therefore be avoided.

Surgery may be considered after a period of 3-6 months of conservative treatment if pain and dysfunction persist. Recovery from surgery can take up to 12 months and has an estimated success rate in the literature of about 89%.

How long’s it going to take?

Acute first-time presentations can often be settled within 4-6 weeks, with return to normal activity in 8-12 weeks. In chronic presentations conservative management can take up to 12 months. It is important to recognise that being pain free does not mean that Achilles Tendinopathy is cured - reorganising that tendon matrix takes time and persistance.

The Take Home

Achilles tendinopathy is a complex spectrum of disease that requires treatment and exercises tailored to the pathology and clinical presentation of the condition. Applying a “one size fits all” approach is unlikely to be effective, prolonging symptoms and resulting in extended time away from work, sport, and social activities. Early physiotherapy intervention and education will greatly benefit people with heel and/or Achilles pain, improving outcomes and reducing time lost to work and sport.

Got heel pain and want to get it sorted? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your heel pain and let you know whether you have bursitis, tendinopathy, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Aicale, R., & Maffulli, N. (2022). Non-insertional Achilles Tendinopathy. In Foot and Ankle Disorders: A Comprehensive Approach in Pediatric and Adult Populations (pp. 855-867). Cham: Springer International Publishing.
Maffulli, N., & Aicale, R. (2019). Update on non-insertional Achilles tendinopathy. Fuß & Sprunggelenk, 17(4), 248-256.
Mitham, K., Mallows, A., Debenham, J., Seneviratne, G. and Malliaras, P. (2021), Conservative management of acute lower limb tendinopathies: A systematic review. Musculoskeletal Care, 19: 110-126. https://doi.org/10.1002/msc.1506
Pavone V, Vescio A, Mobilia G, Dimartino S, Di Stefano G, Culmone A, Testa G. (2019). Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review. Journal of Functional Morphology and Kinesiology. 4(3):46. https://doi.org/10.3390/jfmk4030046
Prudêncio, D. A., Maffulli, N., Migliorini, F., Serafim, T. T., Nunes, L. F., Sanada, L. S., & Okubo, R. (2023). Eccentric exercise is more effective than other exercises in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation, 15(1), 9.
Santacaterina, F., Miccinilli, S., Bressi, F., Sterzi, S., & Bravi, M. (2021). An Overview of Achilles Tendinopathy Management. Osteology, 1(4), 175-186.
Silbernagel, K. G., Hanlon, S., & Sprague, A. (2020). Current clinical concepts: conservative management of Achilles tendinopathy. Journal of athletic training, 55(5), 438-447.

Heel Pain - Retrocalcaneal Bursitis

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 28 Mar 2023 02:21:42 GMT

Getting heel pain? It could be from running too much or high heels!

Retrocalcaneal bursitis is a painful condition felt in the lower Achilles tendon and heel region. Common in active populations such as sports persons and defense force personnel, it is characterized by inflammation of the bursa located between the calcaneus (heel bone) and the Achilles tendon.

A little bit of anatomy

A bursa is a small, thin sac of fluid that functions to reduce friction between moving parts in joints of the body and to cushion and absorb pressure. We have a lot of bursae in the human body – up to 160 – and most are susceptible to irritation and inflammation. The retrocalcaneal bursa sits between the Achilles tendon and the calcaneus and is intimately related to both the tendon and the bone. While irritation and inflammation of the bursa can occur in isolation, it is more frequently found in conjunction with Achilles tendinopathy.

Who gets it?

Bursitis develops when the fluid content of the bursa increases in response to irritation and inflammation. The most common causes of this are overuse, repetitive stress, or direct trauma to the heel, thus why it is common in athletes and sports people. However it also has a high incidence in people who are accustomed to wearing high heel shoes for prolonged periods of time. High heels keep the Achilles tendon in a shortened position. When individuals transition to flat shoes, the tendon is exposed to increased stretch, irritating the Achilles tendon and its associated bursa.

Less commonly, retrocalcaneal bursitis can result from infection or indicate systemic disease such as gout, rheumatoid arthritis, and seronegative spondyloarthropathies – best to consult a health professional to get a clear diagnosis.

Diagnosing Retrocalcaneal Bursitis

Most people who develop retrocalcaneal bursitis present with reasonably consistent signs and symptoms. These might include:

Pain at the back of the heel that is worse when trying to run uphill.
Pain when in tiptoe position.
Tenderness at the back of the heel, aggravated by tight fitting shoes.
Swelling at the back of the heel.
Pain with activities that load the calf.

The challenge is that Retrocalcaneal bursitis rarely presents in isolation, which means if you have bursitis, you probably have a tendon issue as well. A careful assessment by the physiotherapist will help to rule out or rule in other pathologies such as posterior ankle impingement, Achilles tendinopathy, Achilles tendon tear, or a Haglund deformity.

Do I need a scan?

Probably not. In most instances, an x-ray, MRI, or ultrasound will not add much to the clinical picture. In chronic presentations, x-ray might assist with determining if there is any damage to the bone where the tendon inserts. If an Achilles tendon issue is suspected, then ultrasound may assist with prognosis and planning management.

Management of Retrocalcaneal Bursitis

Physiotherapy is a crucial component of conservative management for retrocalcaneal bursitis, helping alleviate pain, restore function, and prevent recurrence. In the acute phase, rest and activity modification is first line treatment. A physiotherapist can provide guidance on suitable activity modifications and gradual return to regular activities, as well as the application of ice several times daily to assist with reducing symptoms. Wearing high heels a lot? You might need to cut back!

Stretching and strengthening programs for the Achilles tendon and calf muscles must be gentle and progressive, allowing the tendon time to adapt to the new load and reduce mechanical stress on the bursa. Manual therapy can assist in addressing joint stiffness, particularly around the ankle and subtalar joints, while biomechanical factors should be addressed via a strengthening program, and, where indicated, with appropriate level orthotics to de-load the back of the heel and support the foot.

Where tendinopathy is present in addition to bursitis, shockwave therapy can be beneficial, though access to this treatment remains limited and expensive in many areas.

Your doctor might prescribe a course of non-steroidal anti-inflammatory medication, and, in recalcitrant cases, corticosteroid injection into the bursa may be recommended. Surgery is only indicated for chronic cases or where a Haglund deformity is contributing to development of retrocalcaneal bursitis. In these instances surgery has been shown to be effective at reducing pain and improving function.

How long’s it going to take?

Acute first-time presentations can often be settled within 2-3 weeks, with return to normal activity in 4-6 weeks. In chronic presentations, or in the presence of Achilles tendon issues, time frames can be many months to control symptoms, load the tendon gradually and develop enough tensile resilience to cope with desired activity.

The Take Home

Retrocalcaneal bursitis is a painful, transient condition of the heel that responds very well to conservative treatment. Physiotherapy plays a vital role in addressing pain, inflammation, and mechanical stress while promoting healing and restoring function. By working closely with a physiotherapist, individuals suffering from retrocalcaneal bursitis can achieve optimal outcomes and reduce their risk of a recurrence.

Got heel pain and want to get it sorted? Give us a call now.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Coombes BK, Bisset L, and Vicenzino B. (2018). Management of lateral elbow tendinopathy: One size does not fit all. Journal of Orthopaedic & Sports Physical Therapy, 48(11), 817-829. https://doi.org/10.2519/jospt.2018.7871
Rahman KH, Arifeen KN, Mahmud CI, et al. (2021). A Study on Outcome of Surgical Treatment of Chronic Retrocalcaneal Bursitis. Mymensingh Medical Journal. 30(4), 903-906. PMID: 34605454.
Roche AJ and Calder JDF. (2013). Achilles tendinopathy: a review of the current concepts of treatment. The Bone and Joint Journal. 95(1), 1299-1307.
Sederberg M and Cushman DM. (2020). Current Treatments of Insertional Achilles Tendinopathy. Curr Phys Med Rehabil Rep 8, 354–363. https://doi.org/10.1007/s40141-020-00288-y
Sorosky B, Press J, Plastaras C and Rittenberg J. (2004). The Practical Management of Achilles Tendinopathy. Clinical Journal of Sport Medicine 14(1), 40-44.
Zhang C, Cao J, Yang L, and Duan X. (2021). Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up. The Journal of International Medical Research. 49(3). DOI: 10.1177/0300060521992959. PMID: 33682490; PMCID: PMC7944541.
Zhi X, Liu X, Han J. et al. (2021). Nonoperative treatment of insertional Achilles tendinopathy: a systematic review. J Orthop Surg Res 16, 233. https://doi.org/10.1186/s13018-021-02370-0

Remedial Massage

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 24 Mar 2023 03:37:57 GMT

Tight muscles? A little stressed or anxious? A good massage will help.

Remedial massage is a complimentary and alternative medicine approach that encompasses a range of techniques to address specific musculoskeletal issues and mental health conditions. Whether you are suffering from chronic pain, anxiety, an injury, or tension in the body, a remedial massage therapy can help as part of a multi-disciplinary treatment plan, individualized to suit your needs and health care goals.

What is Remedial Massage?

Remedial massage is a type of massage therapy that aims to treat musculoskeletal injuries, address mental health conditions, and alleviate pain and tension in the body. Performed by qualified massage therapists, remedial massage is a hands-on treatment that uses various techniques to manipulate the soft tissues of the body, including muscles, tendons, ligaments, and fascia. These techniques may include deep tissue massage, trigger point therapy, myofascial release, and stretching. Massage therapists use their hands, fingers, elbows, and forearms to apply pressure and manipulate the soft tissues to improve circulation, relaxation and improved muscular health.

There are several types of remedial massage, each with its own unique approach and techniques. Some of the most common types of remedial massage are:

Deep Tissue Massage. As the name suggests, deep tissue massage focuses on the deeper layers of muscle and fascia and are more commonly used during injury management or recovery sessions. Deep tissue massage is usually more uncomfortable (what we call “good pain”) as the therapist uses slower, sustained pressure on areas to assist in releasing tight structures and trigger points. These techniques can have far reaching effects and an ultimately soothing effect.

Trigger Point Therapy. This technique involves the application of pressure to specific points in the body that are causing pain or discomfort. These points, known as trigger points, are often found in areas of muscle tension and can refer pain to other parts of the body.

Myofascial Release. This technique focuses on the fascia, a thin layer of connective tissue that surrounds and supports the muscles. The therapist will use gentle, sustained pressure to release tension and adhesions in the fascia.

Sports massage. This type of massage is designed to help athletes prepare for and recover from physical activity. It can help to increase flexibility, improve circulation, and reduce the risk of injury. Read more about sports massage here .

Swedish massage. Although often associated with relaxation massage, a remedial version of Swedish massage uses the same techniques, but with a focus on treating specific conditions. The therapist will use long, flowing strokes and kneading movements to promote relaxation and relieve muscle tension.

Lymphatic drainage massage. This technique involves gentle, rhythmic strokes to stimulate the flow of lymphatic fluid throughout the body. It can help to reduce swelling and promote healing after an injury or surgery.

How does remedial massage work?

Microscopic changes in tissues are a normal process and part of everyday activities including work, sport and leisure. The body responds by repairing the damaged tissue and adapting it to better suit the conditions exposed to. This is how our muscles, tendons and joints develop tolerance to load and get stronger. Sometimes there is inadequate time to allow for the tissues to recover or, in the case of injury, ilness or surgery, damage to soft tissue structures. This can present as muscle and joint tightness, and pain both locally and referred.

Who is it for?

Remedial massage is a key intervention for sports people, and is great for people with chronic conditions such as low back pain, neck pain, arthritis (especially osteoarthritis and ankylosing spondylitis) and diabetes. It can be perfect for relaxation, reducing anxiety and stress, and improving mood as well. Pretty much anybody can benefit from remedial massage. A qualified massage therapist will undertake a thorough assessment with every patient to determine the best appraoch, and use a patient-centred approach to management to achieve the goals of the client.

The Take Home

Remedial massage is a non-invasive, economical way to manage muscle and joint soreness, improve mental health, and reduce injury risk. As part of a multi-disciplinary approach, it forms an important part of the rehabilitation and recovery process post injury and surgery. Make sure your massage therapist is qualified - a diploma in massage therapy is the minimum requirement for you to be able to claim services back through your private health insurer. A good massage therapist knows they are part of a multi-disciplinary team and will work closely with that team to help you achieve better, longer lasting health outcomes.

If you're looking for a Massage therapist, then give us a call.

We have a fully qualified, experienced soft tissue massage therapist on staff who works closely with our physiotherapists.

Give us a call on 08 8945 3799 or Book Online now.

Sources:

Cash, M. (2012). Sports and remedial massage therapy. Random House.

Grace, S., & Graves, J. (2019). Textbook of remedial massage. Elsevier Health Sciences.

Smith, JM, Sullivan, SJ , Baxter, GD . (2010). Massage therapy: More than a modality. New Zealand Journal of Physiotherapy . 38(2), 44-51.

The Achilles Tendon

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 22 Mar 2023 01:20:37 GMT

Don't let Achilles pain become your "Achilles Heel".

The Achilles (uh-ki-leez) tendon is the largest tendon in the human body, and a crucial part of many everyday activities including walking, running, and jumping. Its size develops from exposure to high levels of stress and load from very early life. It’s these same stressors though, and its superficial position, that make it susceptible to injury, particularly amongst athletes and active individuals.

Named after the ancient Greek warrior Achilles, or Achilleus, The Achilles Tendon is a strong fibrous cord that connects two muscles, the soleus and gastrocnemius, to the heel. The shared tendon is about the size of your little finger and can be easily palpated at the back of the ankle .

TOP TIP: Don’t rely on generic exercise programs and treatment remedies to manage Achilles tendon pain. This is a complex area that needs an individualized management plan from your physiotherapist to get better. Read on to find out why.

Nuts and Bolts

The Achilles tendon is a complex structure. Starting as a broad, flat tendon, the two parts (soleus and gastroc) blend together and wind through 90 degrees over their course before inserting into the heel. Along the way, the tendon of another small muscle, plantaris, also blends with the Achilles tendon.

Because if it’s exposed position and the enormous forces it has to deal with, the Achilles has a number of other important physiological structures in the region, including a sheath to cover the tendon and several bursa to protect it from the bone underneath and allow friction free movement. When the soleus, gastrocnemius and plantaris contract, force is translated from the muscle fibers to the heel via the Achilles tendon. This produces plantar flexion of the foot – essentially pointing of the toes or, if we are in standing, lifting of the heel off the ground.

This little system produces 93% of plantar flexion force, thus, it’s importance in activities like walking, running, and jumping.

Risk Factors and Injury Prevention

A few factors can impact risk for developing an Achilles tendon injury. Athletes, particularly those in running and jumping sports, have a higher risk of both acute and overuse injuries. Most individuals are active and involved in recreational or competitive sports. Middle- and long-distance runners, basketball, soccer, tennis and wrestling all have high incidence rates of Achilles tendon injuries.

Males have a significantly greater risk (some studies indicate that up to 89% of Achilles tendon issues present in males), while older people with diabetes are more susceptible to chronic injuries. In children, particularly those aged under 14, Achilles tendon issues tend to occur where the tendon inserts into the heel, known as calcaneal apophysitis or Sever’s Disease.

Other factors that contribute to Achilles tendon issues include ill-fitting footwear, time away from sport (eg. Due to illness or other commitments) and exposure to sudden acceleration and deceleration forces.

Injury prevention relies on identifying risk factors, managing load exposure, and grading return to activities, including work. Identifying risk factors can reduce injury risk, reducing time lost to injury and reducing the economic burden on workplaces and health care systems.

Symptoms of Achilles tendon injuries

Like many tendons, the Achilles is susceptible to injury from overuse or and/or acute mechanisms. It has an injury incidence of 1.85 per 1000 people in the general population, increasing to nearly 1 in 10 in top-level runners. Most of these injuries are classified as tendinopathies, with Achilles tendon rupture representing only 3% of all Achilles tendon injuries.

Overuse Injuries

Achilles tendinopathy. Accounting for 55-65% of Achilles tendon injuries, these are especially common in athletes who participate in sports that require a lot of running and jumping. They are characterized by morning pain and stiffness in the middle and lower portion of the tendon. Ankle range of motion is often restricted. Read more about Achilles tendinopathy here .

Retrocalcaneal bursitis. Affecting the bursa that lies between the tendon and the bone of the ankle, this injury accounts for 25-35% of overuse injuries. It is characterized by pain at the back of the heel, particularly with activities that load the calf, and swelling. Read more about retrocalcaneal bursitis here .

Insertional tendinopathy. This is a distinct injury that can be difficult to differentiate from retrocalcaneal bursitis. It is felt low down on the Achilles, right on the heel bone, and behaves like Achilles tendinopathy (sore and stiff in the morning, restricted movement). In kids it’s known as Sever’s disease. Read more about insertional tendinopathy here and Sever’s disease here .

Acute Injuries

Tendon Rupture. Achilles tendon rupture usually results from exposure to a sudden, high-level force or load. In some older athletes, if there has been a history of tendinopathy or there are chronic changes in the tendon, the load required to produce a partial or complete rupture may be much lower. Achilles tendon ruptures are a significant injury and require expert medical input. Read more about Achilles tendon injuries and their management here .

Management of Achilles tendon injuries

Management is dependent on a clear diagnosis and understanding of the stage of disease. Management varies greatly and is impacted by the location, duration of symptoms and severity of symptoms. Physiotherapists are well placed to assess and diagnose different Achilles tendon problems, and have the knowledge to determine what stage the injury is in and how best to manage recovery. For management of specific Achilles tendon issues, follow the links above or grab an appointment with one of our physio’s.

Mild Achilles tendon injuries can be managed effectively by modifying load, undertaking appropriate exercise therapy, and grading return to activity. More severe presentations may require periods of immobilisation, greater care with loading and, in the case of tendon rupture or recalcitrant tendinopathy, surgical intervention.

Steroid injections provide good short-term pain relief however randomized controlled trials have shown that at 6 and 12 month follow up the outcomes are worse than a wait-and-see approach or physiotherapy.

Physio’s can determine the cause of most Achilles tendon problems, refer for medical imaging or to a GP if indicated, and provide essential education on injury prevention and rehabilitation to prevent future problems. Your doctor may prescribe oral non-steroidal anti-inflammatories. There is conflicting evidence for the effectiveness of these, and it may depend on the phase of the injury. Your doctor or physiotherapist can discuss this with you, as well as general lifestyle modifications, as part of a multidisciplinary approach.

For many people, physiotherapy-led education and guidance on load management are all that’s required. In fact, some studies have shown that 83%-90% of people have significant improvement with a wait-and-see approach. However, up to 33% of people experience symptoms lasting greater than 12 months and many people report recurrent symptoms following the initial episode. So be patient, stay in touch with your physiotherapist, and be diligent with your rehab program.

The Take Home

Achilles tendon injuries are complex, multi-factorial problems that can significantly impact participation in daily living and sports. With a thorough assessment, individualised treatment plan and careful management, most people can recover fully from most Achilles tendon problems. If you are experiencing Achilles Tendon pain or have been diagnosed with an Achilles tendon injury, it is important to consult a healthcare professional, such as a physiotherapist, who can access your condition and develop a personalised treatment plan.

And don’t rely on generic programs - Seek help from a physiotherapist and don’t let that injury become your “Achilles heel”.

Do you have Achilles tendon pain? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your Achilles tendon. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Sources

Doty J, Phisitkul P, Xiao W, Cooper MT, Brigido SA. Update on Acute Achilles Tendon Injuries. Foot & Ankle Specialist. 2019;12(3):278-280. doi:10.1177/1938640019856804
Ferguson A, Christophersen C, Elattar O, and Farber DC (2019). Achilles Tendinopathy and Associated Disorders . Foot & Ankle Orthopaedics, 4:2. https://doi.org/10.1177/2473011419838294
Heckman DS, Gluck GS, and Parekh SG (2009). Tendon Disorders of the Foot and Ankle, Part 2 . The American Journal of Sports Medicine, 37:6, 1223-1234.
Järvinen T, Kannus P, Maffulli N & Khan K. (2005). Achilles Tendon Disorders: Etiology and Epidemiology. Foot and ankle clinics. 10. 255-66. 10.1016/j.fcl.2005.01.013.
Johns W, Walley KC, Seedat R, Thordarson DB, Jackson B, Gonzalez T. Career Outlook and Performance of Professional Athletes After Achilles Tendon Rupture: A Systematic Review. Foot & Ankle International. 2021;42(4):495-509. doi:10.1177/1071100720969633
Lerch TD, Schwinghammer A, Schmaranzer F, et al. Return to Sport and Patient Satisfaction at 5-Year Follow-up After Nonoperative Treatment for Acute Achilles Tendon Rupture. Foot & Ankle International. 2020;41(7):784-792. doi:10.1177/1071100720919029
Schepsis AA, Jones H, Haas AL. (2002). Achilles Tendon Disorders in Athletes. The American Journal of Sports Medicine. 30(2):287-305. doi:10.1177/03635465020300022501

Golfer's Elbow

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 10 Mar 2023 00:40:39 GMT

Golfer's elbow is a common condition, and it's not exclusive to golfers.

Golfer’s elbow, or Medial Epicondylalgia (pron. Epi-con-dil-al-gia), is a painful condition that affects the bony point, the epicondyle, on the inside of the elbow. The name literally means pain (-algia) of the epicondyle. Despite the reference to golf, 90% of cases result from non-sports related activities.

Golfer’s elbow affects about 1% of the general population, yet accounts for between 3.8% to 8.2% of work-related complaints. Like many tendon-based injuries, golfer’s elbow is more common in working females aged between 40 and 60 years, hence its significant economic impact.

TOP TIP: Don’t rely on generic exercise programs and treatment remedies for golfer's elbow. This is a complex injury that needs an individualized management plan from your physiotherapist to get better. Read on to find out why.

Nuts and Bolts

On the inside of the elbow there is a bony prominence call the medial epicondyle. We have 5 muscles originating from this bony prominence, as well as the ulna collateral ligament and the ulna nerve, all of which can be implicated in golfer’s elbow. The muscles predominantly flex the fingers and wrist or pronate the forearm (ie. turn the forearm hand down).

Pain on the medial aspect of the elbow is usually the result of a tendinopathy. As a result of repeated exposure to wrist flexion and gripping activities, the tendon fibres begin to break down. Under normal circumstances, with adequate time to recover, these fibres repair and develop greater tensile resistance. Ie. they get stronger. However, if the tendons are repeatedly exposed to load without adequate time to recover, fibre disruption is compounded, resulting in changes to the tendon structure, irritation of local nerve endings, pain, and restricted function.

Risk Factors and Injury Prevention

There is a lot about golfers’ elbow that we don’t know, particularly why some people seem to develop it, while others doing the same type of activity don’t. From studies on tendon injuries in general though, we know that there are intrinsic and extrinsic risk factors for developing tendon pathology. Intrinsic risk factors include age (35-54 years old is the highest risk), sex (females are more likely to develop tendon injuries), body weight, diabetes, rheumatologic diseases, and a history of smoking.

Extrinsic factors include mostly sports, particularly golf, racquet sports, archery and throwing sports, and occupational related activities that involve forceful, repetitive activities including professions in carpentry, plumbing, and construction. Interestingly, the frequency of golfer’s elbow in eGamers is on the rise!

Injury prevention relies on identifying risk factors, managing load exposure, and grading return to work and sport activities. Identifying risk factors can reduce injury risk, reducing time lost to injury and reducing the economic burden on workplaces and health care systems.

Symptoms

Reported symptoms will vary depending on the structures involved and the mechanism of injury. The cause of a receptionist’s medial elbow pain could be very different to that of a baseball pitcher. Generally though, symptoms include:

Aching pain that radiates down the forearm, with reported tenderness on the inside of the elbow
Stiffness in the elbow joint, particularly in the morning
Weakness in the wrist and hand
Numbness or tingling in the fingers

If left untreated, golfer’s elbow tends to become chronic, with persistent pain, weakness and altered function.

Is it Golfer's Elbow?

Medial elbow pain can have many causes, so don’t assume that just because you have elbow pain you have golfer’s elbow!

Like it’s neighbouring condition tennis elbow , golfer’s elbow is a spectrum of disease, ranging from isolated local tendon damage, through to complex, multi-system (tendon, joint, nerve), and multi-area (elbow, wrist, shoulder and neck) presentations. The duration, location and severity of symptoms will guide the type of intervention recommended, as will the number of episodes of golfer’s elbow experienced in a lifetime.

Diagnosing golfer’s elbow is simple and quick. Most physiotherapists can do this with 3 straight forward tests, though other tests are essential to identify or exclude other potential sources or reasons for symptoms. Medical imaging (xray, ultrasound, MRI) is not usually required to make a diagnosis of golfer’s elbow, and referral to an orthopaedic surgeon is not usually indicated initially.

Managing Golfer's Elbow

Once a diagnosis of golfer’s elbow is established, the challenge is to work out what is happening in the tendon. Understanding the cause of the injury, the phase of the injury (particularly if the tendon is in a reactive or degenerative phase) and issues contributing to symptoms is challenging, and it is these factors that will determine the type and style of rehabilitation you need.

Manual therapy, soft tissue therapy and dry needling can be beneficial in the acute and sub-acute phases of golfer’s elbow in relieving pain and restoring range of movement. These interventions are non-invasive, cheap and have minimal side effects and have good level of evidence for therapeutic use in the first 3-6 weeks.

Exercise plays a critical role in the management of golfer’s elbow long term. The volume, load and type of exercise will be guided by many factors, including the phase of the injury and co-existing biomechanical problems – think shoulder and neck issues – as well as correction of technique.

Your doctor may prescribe oral non-steroidal anti-inflammatories. There is conflicting evidence for the effectiveness of these, and it may depend on the phase of the injury. Your doctor or physiotherapist can discuss this with you, as well as general lifestyle modifications, as part of a multidisciplinary approach.

What about Autologous Tenocyte Implantation (ATI)?

There is often a lot of hype when there is a new treatment approach floated, particularly for a condition like golfer's elbow that can be difficult to manage. While there is some evidence that ATI can be beneficial in reducing pain associated with severe, persistent (greater than 12 months) cases, the research remains inconclusive as to the long term benefits above and beyond conservative management. Currently the cost for ATI is anywhere between $7,500 and $20,000, and it doesn't get you out of modifying your activity or doing your rehab!

The Take Home

Golfer’s elbow is a complex spectrum of disease that requires treatment and exercises tailored to the pathology and clinical presentation of the condition. Applying a “one size fits all” approach is unlikely to be effective, prolonging symptoms and resulting in extended time away from work, sport, and social activities. Early physiotherapy intervention and education will greatly benefit people with medial elbow pain, improving outcomes and reducing time lost to work and sport.

Do you have medial elbow pain and think it might be golfer's elbow? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your elbow pain and let you know whether you do have golfer's elbow, tennis elbow or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Goldfarb J, Grimes JK, and Bauer P (2021) Utilizing Scapular Stabilization Exercises in a Patient With Medial Epicondylalgia: A Case Report , https://doi.org/10.2519/josptcases.2021.9980
Kiel J, Kaiser K. Golfers Elbow. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2022. PMID: 30085542.
Svernlöv B, Hultgren E, Adolfsson L. Medial Epicondylalgia (Golfer’s Elbow) Treated by Eccentric Exercise. Shoulder & Elbow. 2012;4(1):50-55. doi:10.1111/j.1758-5740.2011.00152.x
Waldman SD (2019). Golfers Elbow. In: Atlas of Common Pain Syndromes (Fourth Edition), https://doi.org/10.1016/B978-0-323-54731-4.00039-6

Early Intervention for Musculoskeletal Injuries

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 08 Mar 2023 01:45:13 GMT

Early intervention improves outcomes and reduces healthcare costs.

‘Complete mayhem’ as healthcare system buckles under pressure.

This was the headline to an article in The Sydney Morning Herald on 11 ^th June 2022. On the back of the pandemic, Australia’s tertiary health care facilities (hospitals and emergency departments) and GP providers have been overwhelmed. Doctors are tired, sick and burnt out. Looking for a GP appointment? You could be waiting a couple of weeks.

Research studies tell us that 30% of Australians live with a chronic musculoskeletal problem.

Acute and chronic musculoskeletal injuries are one of the most common reasons people present to A&E in Australia – things like fractures, back pain, ligament sprains and joint injuries. All up these account for over a quarter of all presentations to A&E and, accounting for co-morbidities, are a factor in nearly half of all presentations to a GP. While some of these presentations will require expert medical management (surgery, radiology, pharmacy, pathology tests), many could be managed effectively elsewhere. This inefficient use of health care resources is just one factor overwhelming the system, contributing to delays in treatment for musculoskeletal conditions that are detrimental to the patient and economically unsustainable.

How so?

Delayed treatment of musculoskeletal conditions has been shown to have numerous detrimental implications to the individual. Consider the following possible complications from delayed treatment:

Gradual worsening of symptoms over time.
Increased peripheral and central sensitisation with associated increase in pain.
Greater dependency on oral pain relief (paracetamol, non-steroidal anti-inflammatories).
Reduced joint range of motion.
Muscle atrophy (basically loss of muscle strength)
Deconditioning and reduced functional capacity.
Reduced capacity to work.
Depression and anxiety (Mental health considerations).

Delayed treatment can have broader social and economic implications as well.

For example, delayed treatment can lead to increased healthcare costs, as individuals with untreated or poorly treated injuries may require more extensive treatment and care. Delayed treatment can also lead to increased absenteeism from the workplace and decreased productivity, which can have significant economic impacts for both individuals and their employers.

Moreover, delayed treatment can impact the mental health and wellbeing of individuals, as the stress and uncertainty of a prolonged recovery process can be challenging to manage. This last point is particularly pertinent given that the HIGHEST reason to see a GP is for mental health issues.

To mitigate the impacts of delayed treatment on musculoskeletal injuries, it is important to prioritize early intervention and timely access to appropriate healthcare services. This includes providing access to physiotherapy and other rehabilitation services, as well as ensuring that individuals have access to appropriate pain management strategies and mental health support.

The Role of Physiotherapy

Physiotherapy in particular is well placed to assist in this space. Being a primary health care provider, as a consumer, you do not need a referral to come and see a physiotherapist ^#1 .

Physiotherapists:

Are highly trained health care professionals.
Are skilled at triaging acute musculoskeletal injuries.
Can assess, diagnose and treat most acute musculoskeletal injuries.
Can effectively manage return to normal activity, be that social, work or sport.
Can refer you for an x-ray, MRI or ultrasound if indicated.
Work closely with local health networks and so can facilitate referral to GP’s, surgeons and other allied health professionals.

Solutions Approach

Through offering early intervention musculoskeletal injury assessments, Movement For Life Physiotherapy hopes to assist the local community and employers ^#2 by reducing some of the burden on our overstretched health care services. We’ve put on extra clinical staff and are ensuring individuals can access a physiotherapist within 24 hours (or the next business day) of sustaining a musculoskeletal injury to get the ball rolling.

We appreciate this isn’t going to solve the health crisis in Australia, but it will provide another option for local people and, through educating people about their options for managing acute musculoskeletal injuries, we hope to contribute to change around health care access in Australia.

Have you suffered an acute musculoskeletal injury ? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons and offer early intervention as part of a comprehensive health care service that is personalised, goal-oriented and outcome focussed.

Call now on 08 8945 3799 or book online.

Notes

#1. If you have sustained an injury and are covered by a compensable body (such as Workers Compensation, Motor Accident Commission, DVA) or if you have a chronic condition and are seeking treatment covered by Medicare, then you need to see your GP first.

#2. If you have sustained a musculoskeletal injury at work, check with your employer to see if they will allow you to access physiotherapy under an Early Intervention program .

Sources

Campbell P et al (2022). The Effects of Early Physiotherapy Treatment on Musculoskeletal Injury Outcomes in Military Personnel: A Narrative Review. https://doi.org/10.3390/ijerph192013416

Dinh MM et al (2016). Understanding drivers of Demand for Emergency Service Trends in Years 2010–2014 in New South Wales: An initial overview of the DESTINY project. doi: 10.1111/1742-6723.12542

Ojha HA et al (2016). Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. https://doi: 10.2519/jospt.2016.6138

Zurynski Y et al (2021). Accessible and affordable healthcare? Views of Australians with and without chronic conditions. https://doi.org/10.1111/imj.15172

https://www.medicalrecruitment.com.au/blog/2018/09/the-top-10-most-common-gp-visits?source=google.com

https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/musculoskeletal-conditions/contents/summary

https://www.smh.com.au/national/nsw/complete-mayhem-as-healthcare-system-buckles-under-pressure-20220603-p5aqtj.html

Acute Wry Neck

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 03 Mar 2023 01:10:30 GMT

Neck a little twisted and tilted? Get that acute wry neck treated fast.

Acute wry neck, also known as acute torticollis, is a painful medical condition characterized by a twisted or tilted neck. The name comes from the Italian "torti colli", which translates to twisted neck and, in most instances, is a transient condition that responds well to physiotherapy.

It is estimated that at least 90% of people will experience at least one episode of torticollis at some point of their lives.

Anatomy 101

To understand how a acute wry neck occurs, we need to appreciate some of the basic anatomy of the neck and how complex the neck muscles are. Broadly speaking, we have a layer of superficial neck muscles collectively referred to as the long neck muscles, and deep neck muscles (referred to as the paravertebral muscles). With acute wry neck, it is the superficial muscles that are most affected.

While any of the neck muscles can be implicated in a acute wry neck, the main offender is the sternocleidomastoid muscle (SCM). It lies in the front region on either side of the neck and runs from just below the ear to the top of the sternum. It has unique muscle fibres that run obliquely upward and outward allowing it to laterally flex the neck to the same side and rotate to the opposite side (so the left SCM will laterally flex the neck to the left and rotate the head to the right). Working together, both SCM’s flex the neck and play a role in breathing and swallowing.

How did this happen?

The most common cause of a acute wry neck is muscle strain, either from an acute injury or from poor posture. Many people will wake in the morning with a acute wry neck, and so it is common to put the cause down to poor support from a pillow or a cold draft on the neck overnight. While these might contribute to the development of a acute wry neck, the more likely cause is either a strain of a neck muscle (such as might occur with a whiplash injury), a chronic strain from poor posture, or facet joint irritation that results in muscle spasm.

Other causes of a wry neck include:

Sleeping in an awkward position.
Infection.
Repetitive neck movements.
Neurological conditions.
Spasmodic torticollis such as dystonia triggered by emotional stress, physical overload, or sudden movement.
Congenital torticollis.

Managing a acute wry neck.

Physiotherapists bring a wholistic approach to their management of musculoskeletal injuries and use a variety of techniques that have good evidence for their effectiveness, so it's a great place to start if you have a acute wry neck. Physiotherapists are skilled at assessing and diagnosing acute wry necks, and can determine in most cases the cause and refer for further investigations (xray, MRI) or to a doctor if necessary.

People with a acute wry neck can present with a variety of symptoms. Most commonly they will have pain and restricted neck movement, with the head held in a distinctive ‘twisted’ position that is painful to move away from. Other symptoms include:

Headache
Dizziness
Nausea
Difficulty swallowing
Shoulder pain

In some cases, acute wry neck may be accompanied by other neurological symptoms such as pins and needles, paraesthesias or upper limb weakness.

Treatment will depend on the underlying cause of the acute wry neck, and that is why a thorough assessment is always required. Rest, heat, soft tissue massage and gentle joint mobilization can be really effective in reducing pain and improving range of motion. Dry needling has also been shown to be effective, particularly in cases where facet joint irritation is implicated. We don't advocate for the use of neck braces as they deload the neck muscles making them weaker and can contribute to increased joint stiffness, potentially prolonging the recovery process.

Patience is required, and a good physio will advise it might take some time to settle pain and regain range of motion.

As symptoms resolve, a tailored exercise program to improve strength and posture for the long term is essential. Surgery is rarely indicated for a acute wry neck, and is typically only considered as a last resort when other treatments have failed to improve the condition. In general, surgery is indicated for wry neck when the underlying cause of the condition is structural or neurological in nature.

How long is it going to take?

Again, this depends on the underlying causes of your acute wry neck, the duration of symptoms and how you respond to treatment. The usual course for a acute wry neck can be a few days to several weeks, while for chronic presentations it could take a few months for symptoms to resolve and exercises to be an effective management tool.

The Take Home.

Acute wry neck is a common presentation that responds well to physiotherapy intervention. Be patient - most acute wry necks resolve nicely within a few days to a few weeks with appropriate treatment. Where treatment is not undertaken, symptoms may resolve however if the underlying causes of a acute wry neck are not addressed, further episodes can occur, with symptoms progressively becoming harder to manage carrying a higher risk of chronicity.

If your looking for some more information on the management of acute neck pain, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you have neck pain or a acute wry neck? Give us a call.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Resources:

Brukner, P., & Khan, K. (2012). Clinical Sports Medicine, 4th Edition
Neck Pain: Clinical Practice Guidelines Help Ensure Quality Care. J Orthop Sports Phys Ther 2017;47(7):513. doi:10.2519/jospt.2017.0508
Neck Pain: Dry Needling Can Decrease Pain and Increase Motion. J Orthop Sports Phys Ther 2014;44(4):261. doi:10.2519/jospt.2014.0502
Shanmugam S, Mathias L. Immediate Effects of Paraspinal Dry Needling in Patients with Acute Facet Joint Lock Induced Wry Neck. J Clin Diagn Res. 2017 Jun;11(6):YM01-YM03. doi: 10.7860/JCDR/2017/26407.10079. Epub 2017 Jun 1. PMID: 28764281; PMCID: PMC5535471.
Tomczak KK, Rosman NP. Torticollis. Journal of Child Neurology. 2013;28(3):365-378. doi: 10.1177/0883073812469294
Vos, C., Verhagen, A., Passchier, J., & Koes, B. (2007). Management of acute neck pain in general practice: a prospective study. British Journal of General Practice, 57(534), 23-28.

The benefits of a warm-up before sport

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 24 Feb 2023 06:34:20 GMT

Are you doing a proper warm-up? It could save you some pain.

Playing sport, we become accustomed to the routine of arriving with time before the game or activity starts, doing a warm-up, keeping active during our time on the bench, and maybe even doing a cool down after the game.

But why do we do these things? Do they reduce the risk of injury? And what about if the weather is already warm – do I still need to warm up? Read on to learn more about the importance of the warm-up.

Have you ever watched the lead up to a car race? The cars are started in the pits, engines warmed up, adjustments made to suspension and steering, before the cars head out for warmup laps to get the fuel and oil through the system, and the tires warmed up and to the right pressures.

Humans are no different (in fact, we’re far more complex). Studies have shown that a warm-up can improve performance in up to 78% of criterions, including running, jumping, throwing and cycling. That’s why a warm-up is a crucial part of any physical activity. Here are some of the benefits of doing a warm-up before a sport:

Improve performance. A proper warm-up can help to improve performance by increasing blood flow to the muscles, which can enhance muscle contraction and speed of movement. It also helps to improve range of motion, which can increase flexibility and agility.

Mental preparation. Get in the zone! A warm-up will also help you to mentally prepare for competition, allowing you to focus on performance and strategy. It can also help to reduce anxiety and stress.

Injury rehabilitation. For athletes recovering from injuries, a warm-up can help to increase blood flow to the injured area, which can aid in the healing process and prevent further injury.

If we delve a little deeper, the warmup plays an ever more important role.

Every muscle, tendon, ligament and joint has a nerve supply to it, making the muscle contract and relax, sending feedback to the brain on the current state of play, modifying blood flow, even calling on different energy systems depending on the type of activity we are performing. We call this the neuromuscular system, and gradually firing this system up is a key part of the warmup.

Increased nerve conduction velocity. As we warm up the number of nerves firing and the speed at which these nerve impulses travel from the brain to the muscles increases, improving muscle response time, reaction time and coordination.

Enhanced muscle activation. If the warm-up is activity specific and practices the skills and movement patterns relevant to the sport, the warm-up can help activate the right muscle groups, improving muscle function and reducing the risk of injury.

Improved muscle flexibility. Immediately following a maximal muscle contraction, we get maximal relaxation – contract, relax, contract, relax. By firing the neuromuscular system up, we enhance muscle flexibility, reducing muscle stiffness and improving joint mobility. This can enhance range of motion and reduce the risk of injury.

Improved motor skills. By improving neuromuscular activity, a warm-up can also help to improve motor skills such as balance, agility, and reaction time.

What about injury prevention?

Well, a warm-up won’t prevent an injury, but it will reduce the risk of injury. Through all the mechanisms we have already discussed, the warm-up prepares the body for physical activity – increasing blood flow, improving joint mobility and activating the muscles. Done in a gradual, progressive manner, the body is able engage the different physiological systems required, adjust to the external environment effectively and provide valuable feedback to our conscious self (oh, I didn’t realise that hamstring was feeling a little tight) and go on to perform at our best.

What about in warm weather?

Well, yes. Even though our internal temperature might already be a little higher and our metabolism running a little faster, we still need to engage the muscle groups important to the activity and get those nerves and neurons firing. Remember, if you are exercising in the heat, consume greater volumes of water and consider doing some of the warm-up in the shade.

The Take Home

Think back to our car analogy at the start. Even the brains behind the wheel, the driver, does prep before jumping into the car – including mental imagery, stretches, and massage. So get in the habit of going through a warm-up every time you play sport. Not only will you perform better, you’ll enjoy the contest more, get better results, and suffer less injuries.

Need some help with a warm-up plan? Give us a call. We are part of a well-connected network of local physiotherapists, with extensive experience in sports physiotherapy and can guide you through a tailored warm-up program to keep you doing what you love.

Give us a call on 098 8945 3799 or book online.

References

Fradkin, AJ et al (2010). Effects of Warming-up on Physical Performance: A Systematic Review With Meta-analysis. Journal of Strength and Conditioning Research 24(1), 140-148. https://doi.10.1519/JSC.0b013e3181c643a0
Knudson, D. V. (2018). Warm-up and Flexibility. In Conditioning for strength and human performance (pp. 212-231).
Routledge.McGowan CJ, et al. (2015). Warm-up strategies for sport and exercise: mechanisms and applications. Sports Medicine. https://doi.org/10.1007/s40279-015-0376-x
Racinais S. et al (2015). Consensus recommendations on training and competing in the heat. Scandinavian Journal of Medicine and Science in Sports. https://doi.org/10.1111/sms.12467
Zois J et al (2011). High-intensity warm-ups elicit superior performance to a current soccer warm-up routine. Journal of Science and Medicine in Sport. https://doi.org/10.1016/j.jsams.2011.03.012

The Knee - Anterior Knee Pain

nick.jones@mflphysio.com.au (Nick Jones) — Sat, 04 Feb 2023 07:24:41 GMT

Anterior knee pain has many causes and treatments. What's causing yours?

Many of us will experience pain in the front of the knee at some stage in our lives. Often it can begin with a minor ache, perhaps some crunchiness when ascending stairs or playing sport, or kneecap (patella) stiffness when we first get out of bed. Left untreated anterior knee pain can get progressively worse, and in some situations have significant, life changing consequences.

Anatomy 101.

The anterior knee consists of 3 joints – the tibiofemoral joint, the patellofemoral joint and the superior tibiofibular joint. Any of these joints can contribute to anterior knee pain, though more commonly it is the patellofemoral joint. There are lots of structures in here, including muscles, fat pads, tendons, ligaments and bursa, all of which can contribute to anterior knee pain.

Most commonly, anterior knee pain is a consequence of dysfunction from either above or below the knee joint, resulting in abnormal biomechanics and load on anterior knee joint structures.

What’s it all about?

The term Anterior Knee Pain is a descriptive term only, not a diagnosis. People with anterior knee pain may have any number of conditions which is why assessment and diagnosis by a qualified health professional, like a Physiotherapist, is important. Some of these conditions are listed below (there’s a lot), with links to articles to help you understand them better (we’re working on our own versions of these, but these are trusted resources too).

Patellofemoral Pain Syndrome
Chondromalacia Patellae
Osgood-Schlatter’s disease
Sinding Larsen Johansson syndrome
Plica synovialis syndrome
Knee bursitis or Hoffa’s disease
Articular cartilage injury
Bone tumours
Osteochondritis dessicans
Patellofemoral instability/subluxation
Patella stress fracture
Patella tendinopathy
Patellofemoral osteoarthritis
Pes anserine bursitis
Quadriceps tendinopathy
Prepatella bursitis
Iliotibial Band syndrome
Hip and low back joint (yep, the hip and the lower back can refer pain to the anterior knee)

Signs and symptoms of Anterior Knee Pain

Anterior knee pain is often multifactorial, which means there are a number of factors contributing to the presentation. Symptoms can vary hugely, from the location and intensity of pain experienced, to the activities that cause it and those that help relieve it. Factors contributing to anterior knee pain include muscle weakness, muscle imbalances, joint compression, overuse, tightness, and malalignment, causing injury and dysfunction to a variety of structures around the knee.

Some of the structures that might be implicated in anterior knee pain include joint surfaces, ligaments,

tendons, muscles and bursae.

Because anterior knee pain can be caused by so many different conditions, presentations often vary from person to person. Some people will report pain with activities of daily living such as stairs and driving the car, some only with sports (basketball and volleyball are common culprits). For some people, wearing high heels can be the problem, while for others, it might be sitting on a plane or in a movie theatre.

What to do, what to do…

Diagnosis of the cause of your anterior knee pain requires patience and skill. Your physiotherapist will often spend a lot of time asking you about how your knee pain developed, how it has behaved over time, what aggravates it and what relieves it. A physical assessment will include observing how the knee joint behaves with activities such as walking, squatting, kneeling, and jumping, paying particular attention to what your kneecap (patella) wants to do. Assessing the knee for swelling, checking joint range of motion, and palpating different structures will help diagnose the cause of your knee pain. Your physio will also assess your ankle, hip, and lower back, just to make sure they are not contributing to symptoms as well.

The best treatment? Exercise

Firstly, don’t go searching the web for a quick fix exercise program for anterior knee pain. As you have probably worked out, anterior knee pain can have many different causes.

Treatment and management must be specific to your presentation and prescribed by someone

who knows what they are doing.

Depending on how long you have had anterior knee pain and the cause, it may take a few weeks or a few months for symptoms to settle and resolve. Most treatment plans will involve a period of hands-on treatment to assist with settling symptoms such as pain and stiffness. Modification of activity and load exposure is an important part of managing many of the causes of anterior knee pain. Your physio can advise some strategies to assist with this, including activity modification, and prescribe a graded exercise program to help stretch tight structures, strengthen the right muscles, and improve biomechanics. Importantly, these programs will be individualised relative to the presenting symptoms and movement dysfunction. There are a variety of taping techniques and knee braces that can be really helpful with anterior knee pain, so chat with your physio about these as well.

The Take Home

Anterior knee pain is a descriptor, not a diagnosis. There are a range of conditions that produce anterior knee pain, and getting a correct diagnosis is the key to resolving your symptoms. Don’t rely on generic information and fad exercise programs. Get the opinion of an expert and stick to the management plan – most anterior knee pain can be fixed, but you need to be patient and committed.

If your looking for some more information on the management of Anterior Knee Pain, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Got anterior knee pain and want to know the cause? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your anterior knee pain and let you know whether you have patella tendinopathy, patellofemoral pain syndrome, or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Cervicogenic Headache

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 21 Nov 2022 03:51:31 GMT

Neck pain and a headache? The two could be linked.

Cervicogenic (ser-vy-co-jen-ic) headache is an identified form of headache that originates in the neck and refers pain to one or more regions of the head and/or face. Implicated in 1-4% of headache presentations, cervicogenic headache is more common in 30-44 year-olds and is characterised by pain generally on one side of the head/face, diffuse shoulder pain and reduced neck movement.

Anatomy 101

To understand how we get a headache from the neck, we need to broach the topic of referred pain and try to understand at least a little about the structure of the neck , how information is processed, and how the bones (vertebra), joints, and muscles share nerve pathways with the head.

The neck is comprised of 7 cervical vertebrae, and it is the first 3, C1-3, that are generally implicated in cervicogenic headache.

There is a spinal nerve root at each level, which essentially is a relay between the nerve receptors in the periphery (things like our skin, joints, muscles, and organs) and the brain, which is tasked with working out what all this information means. On route to the brain, the nerve signal passes through part of the spinal cord called the trigeminocervical (tri-gem-e-no-ser-vy-cal) nucleus. This nucleus also receives input from the skin and muscles of the head and face (via the Trigeminal nerve), so it’s kind of like a melting pot for all this information coming in. The nucleus then passes info on to the brain, which has the task of putting the incoming signals into context and producing an output. Confused? Click here to see a diagram of this.

In the case of cervicogenic headache, a problem in the neck, be it muscle tightness or joint degeneration, sends lots of signals to the trigeminocervical nucleus via the nerve root. This increased signal generation can upregulate the trigeminocervical nucleus making it more sensitive to all inputs, including those coming in from the head and face. In a sensitised state, it then bombards the brain with signals. The brain cannot accurately decipher whether the information is coming from the neck or via the trigeminal nerve and perceives it as symptoms, often pain, in the head and/or face.

Causes

Now that we understand the link between the neck and the head, we can start to explore some of the causes of cervicogenic headache. A key thing to understand here is that the neck is the driver of the headache. In a cervicogenic headache, there will always be an underlying problem in the neck or the muscles around the neck. Some of the known causes include:

Trigger points . These are small, focal, nodular bundles located within a taut band of skeletal muscle that, when compressed, are painful and refer pain in distinct patterns. They can develop from a range of causes, including stress, poor posture, and activity such as cycling and swimming. Trigger points located in the trapezius and sternocleidomastoid muscles have been implicated in cervicogenic headache.
Facet joints changes. These small joints located on the side of each cervical vertebrae are subject to acute injury (eg. whiplash) and to degenerative changes as we age. This can affect local muscles, ligaments, and joint surfaces. Facet joint changes at the C1-3 levels are recognised as potential causes of cervicogenic headaches.

There are plenty of other tissues that can contribute to cervicogenic headache though, so best to get it assessed properly.

Assessment

The first step to treating cervicogenic headache is determining the cause of symptoms. Excluding other causes of headache is a key part of this, so a full musculoskeletal assessment should be undertaken.

The International Headache Society has established diagnostic criteria for cervicogenic headaches.

These guidelines were last updated in 2018 and are used to guide the diagnosis of cervicogenic headache. Common presenting symptoms include neck pain, restricted neck mobility, occiput and frontal headache, and at times shoulder pain. Symptoms can be improved with rest and aggravated with movement of the neck especially neck extension, rotation, and lateral flexion.

In some instances, your physiotherapist or doctor may refer for x-ray to determine the influence of joint degeneration on individual symptoms. And if your headache is a tension headache or migraine, then you’re best seeing your doctor and getting appropriate medication prescribed.

Treatment

Physiotherapists bring a wholistic approach to managing cervicogenic headache and are skilled in using a variety of techniques that have good evidence for their effectiveness. Manual therapy, dry needling, soft tissue massage techniques and therapeutic exercise all play a role in treating and managing cervicogenic headache, helping to restore joint mobility, reduce active trigger points, improve muscle function, and correct posture and biomechanics.

As symptoms resolve, exercise plays an important role in maintaining neck mobility and reducing muscle tightness. Stretches, strengthening and self-management techniques can assist with improving muscle endurance, posture and desensitizing neural inputs to the spinal cord and brain.

A usual course of care for cervicogenic headache will take between 6-12 weeks.

This can seem daunting to many patients, but it allows time to make sustainable changes to people’s lives including reducing pain, addressing causative factors and building resilience. Your physiotherapist will provide you with a treatment plan that outlines the stages of physio intervention, the treatment recommended for your presentation, and expected milestones along the way.

Do you have neck pain and a headache? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons and can treat and manage cervicogenic headache that is personalised, goal-oriented and comprehensive.

Call now on 08 8945 3799 or book online.

Resources:

Cardoso R, Seixas A, Rodrigues S, Moreira-Silva I, Ventura N, Azevedo J and Monsignori F (2022). The effectiveness of sustained natural apohyseal glide on flexion rotation test, pain intensity, and functionality in subjects with cervicogenic headache: A systematic review of randomized trials. Archives of Physiotherapy, 12-20, https://doi.org/10.1186/s40945-022-00144-3
Parikh, S.S., Salazar, T., Taborda, R. (2022). Neck Pain: Whiplash and Cervicogenic Headache. In: Mostoufi, S.A., George, T.K., Tria Jr., A.J. (eds) Clinical Guide to Musculoskeletal Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-92042-5_8
Nassery, A., Schuster, N.M. (2020). Cervicogenic Headache. In: Mao, J. (eds) Spine Pain Care. Springer, Cham. https://doi.org/10.1007/978-3-030-27447-4_15
https://www.physio-pedia.com/Cervicogenic_Headache
https://choose.physio/your-body/neck/neck-related-cervicogenic-headache

The Shoulder Joint - Shoulder Subluxation

nick.jones@mflphysio.com.au (Nick Jones) — Mon, 21 Nov 2022 03:33:40 GMT

Early treatment can prevent a full dislocation and chronic pain.

The shoulder joint is a ball and socket joint made up of the head of the upper arm (the humeral head) and the glenoid fossa of the shoulder blade. It is one of the easiest joints to sublux and dislocate, resulting in shoulder pain and instability, which can have a significant impact on day-to-day activities.

Anatomy 101.

The shoulder has a lot of natural mobility, which is great for many of the daily activities and sport we like to participate in. Hanging washing, throwing a ball, swimming, playing tennis, scratching our backs, even dressing, are all reliant on the large range of motion in a normal functioning shoulder joint. However, this vast degree of mobility comes at a cost to stability. The shoulder joint has a relatively large head compared with the socket ( Click here to see ). It therefore relies heavily on ligament and muscle support, and an intact labrum - a fibrocartilage ring that surrounds the socket, deepening this part of the shoulder joint and increasing the contact surface area with the humeral head.

When the muscles and ligaments that provide this dynamic support are injured, stretched, or not functioning properly, shoulder subluxation can occur and, in advanced cases or when high forces are involved, shoulder dislocation.

What’s it all about?

Shoulder subluxation is part of the spectrum of injury called shoulder instability that includes shoulder dislocation in its most advanced form. Shoulder subluxation occurs when the upper part of the arm, the head of the humerus, is separated from the socket, called the glenoid fossa. With a subluxation, while the joint does separate, the joint itself maintains congruence, as opposed to a dislocation when joint congruence is disrupted and requires assistance to relocate. For more on shoulder dislocation, click here.

Shoulder subluxations are most commonly the result of repetitive exposure to loads that distract the joint. As a result, the soft tissues surrounding the shoulder joint that provide it with stability are stretched and weakened. Without these effective dynamic stabilisers, the shoulder joint becomes unstable and subluxation can occur. Activities that expose the shoulder to these loads include throwing (cricket, baseball), tennis, swimming, and volleyball.

Other examples of situations where shoulder subluxation can occur include:

When the arm is pulled forward away from the shoulder joint force fully, as might happen when water skiing or being swung around by another individual.
A force to the back, top or front of the shoulder, such as might occur in a fall or when playing contact sport such as AFL or rugby.
A fall onto an outstretched arm such as might occur in the garden, snowboarding, or playing soccer.
In a motor vehicle accident
Muscle weakness or nerve injury, as might occur in people with hemiplegic stroke or with a paralysed upper limb.

Left untreated, shoulder subluxation will further weaken the dynamic stabilisers, resulting in ongoing, progressive instability, biomechanical dysfunction, and increased risk of more advanced shoulder joint pathology including subacromial impingement, rotator cuff tears and shoulder dislocation.

Signs and symptoms of Shoulder Subluxation

People with shoulder subluxation will generally have a history of playing sport or being exposed to an event or activities that adversely affect shoulder stability. Onset of symptoms is often gradual, and people will report pain, swelling, weakness, and pins and needles feeling in the arm. Many people are also apprehensive about certain positions, citing a fear of the shoulder “popping out”.

The resulting pain and dysfunction can impede normal muscle function and joint mechanics, and the person can report repetitive instances of shoulder joint instability. If there is damage to other structures, such as the labrum, episodes of instability may be accompanied by a clunk.

What to do, what to do…

If you have experienced shoulder subluxation, then you need a good physio. A thorough interview and assessment will help the physiotherapist understand your mechanism of injury, your symptoms and pain experiences, and how it is impacting your daily activities. Xray can be beneficial in helping identify the extent of shoulder subluxation, looking at the gap that has developed between the head of the humerus and the bony point of the shoulder, the acromion. Some special tests such as an apprehension test and push-pull test, strength tests and joint mobility tests will help the physiotherapist diagnose shoulder subluxation and provide you with a comprehensive treatment plan.

The best treatment? Exercise

In most instances, shoulder subluxation can be effectively managed with a short phase of hands-on therapy combined with therapeutic exercise. Your physio’s advanced knowledge and understanding of tissue properties will ensure the right structures are loaded and strengthened to deliver the best outcomes. Your physiotherapist will adjust the load, angle, and range of exercises to ensure the right structures are protected and strength gains are optimal. Importantly, this will be different for each individual patient.

Other treatment options include electrical stimulation of muscle, particularly in the presence of nerve damage or stroke. In some instances, surgery is indicated to “tighten” the shoulder joint and help restore normal biomechanics.

Got shoulder pain, an unstable joint or subluxed your shoulder? Give us a call.

We are part of a well-connected network of physiotherapists, orthopaedic surgeons and doctors and can provide you with a comprehensive treatment plan to get you back to doing what you love to do.

Give us a call on 098 8945 3799 or book online.

Diabetes

Wed, 02 Nov 2022 01:54:36 GMT

Diabetes is a growing problem - Are you exercising enough?

Diabetes is a group of chronic metabolic conditions characterized by elevated blood glucose (or sugar) levels, resulting from the body’s inability to produce insulin, a developed resistance to insulin action, or both. Worldwide, it is the fastest growing chronic condition and a significant community health problem.

In Australia, with 280 new diagnoses daily, diabetes is estimated to cost $14.6 billion annually, and affects 25% of people aged 65 and over.

There are several different types of diabetes:

Type 1 Diabetes. This is usually diagnosed in childhood and results from auto-immune beta-cell destruction in the pancreas, resulting in a complete lack of insulin production. Basically, the body does not produce insulin.

Type 2 Diabetes. This is the most common form and accounts for 90-95% of all diagnosed diabetes cases. It develops when there is increased resistance to the action of insulin and the body cannot produce enough insulin to overcome the resistance. The pancreas eventually reduces or may even cease production of insulin. Importantly, type 2 diabetes is classified as a modifiable disease.

Gestational Diabetes. Occurs affects some women during pregnancy and usually goes away after the baby is born.

Other causes. Diabetes can also result from genetic defects affecting beta-cell function or insulin action, disease of the pancreas (eg. cancer), drugs or chemical toxicity.

Understanding Diabetes

In a healthy system, sugars from the food we eat enter the blood stream via the stomach. The central nervous system, through a variety of mechanisms, detects increased glucose levels in the blood and stimulates the pancreas to release insulin to maintain blood glucose levels within a set range.

In Type 1 Diabetes, the loss of insulin-producing beta cells results in an absolute insulin deficiency. People with Type 1 diabetes use insulin injections to maintain sufficient levels of insulin in their system, which in turn helps control blood glucose levels.

In Type 2 Diabetes, the body has developed resistance to insulin. Initially the pancreas responds to sustained high blood glucose levels by increasing insulin production. Over time though, the mechanisms that stimulate the pancreas to release insulin become resistant to the chronically elevated blood glucose levels. As a result, insulin production diminishes, resulting in elevated levels of blood glucose.

Left untreated, diabetes results in a range of other diseases, severe organ damage and reduced life expectancy by 10-20 years.

Lifestyle changes, improved diet and increased exercise are essential in successful control of diabetes.

Risk Factors for Diabetes

Diabetes has what we refer to as modifiable and nonmodifiable risk factors. Nonmodifiables are things we can’t change, like our age and family history. Modifiables can be changed, things like diet and inactivity, and this is where assistance from health professionals is critical. Click here to see the different risk factors for diabetes.

How does exercise help

The benefits of exercise in the prevention and management of diabetes are well recognised. When we exercise, our muscles burn glucose and body fat to produce energy and movement, thereby reducing blood glucose levels and, over time, reducing body weight. Exercise improves cardiovascular fitness, which in turn can assist in lowering blood pressure and improve blood flow to the periphery - namely our feet and hands. Then you have all the added benefits of exercise, like improved mood, cognitive function, joint health, and body strength. Hard to argue with that.

Why Physiotherapy?

Physiotherapists bring a wholistic approach to managing diabetes and are skilled in treating co-morbid presentations (for) example, diabetes in the presence of osteoarthritis).

Some of the key roles Physiotherapists play include:

Providing guidance on physical activity participation for patients who have or are at risk for diabetes . Physiotherapists commonly prescribe physical activity for the treatment of diabetes and other chronic diseases such as cardiovascular disease and osteoarthritis. As primary care practitioners, they are well placed in the community to provide advice in this area. With a deep understanding of the causes of diabetes, the body’s responses and risk factors for other disease and illness, physiotherapists can provide individualised, varied, and engaging programs to help pretty much anyone, with programs monitored and modified to meet individual goals and objectives.

Regularly screening patients for risk factors for diabetes and diabetes-related complications. Physiotherapists can provide treatment and education in self-management strategies, prescribe safe and rewarding physical activity, and monitor and treat related illnesses and disease.

Chest pain, stroke, reduced circulation in the limbs and sensory changes are all serious medical conditions that can result from diabetes.

Physiotherapists are skilled at monitoring foot care and peripheral circulation, identifying other organ disease symptoms and signs, and working with a multi-disciplinary team to minimise complications and improve your quality of life.

Advocating for regular physical activity as a key component of treatment of chronic diseases in all patient interactions. Physiotherapists know the benefits of exercise, not just for diabetes, but for a whole range of conditions. By modifying, adapting, and progressing exercise through the life span, physiotherapists can reduce the risk of diabetes and other organ disease, reduce falls risk, reduce the incidence of fractures in our elderly, keep people active in sports and recreational activities for longer periods, and have a real impact on both physical and mental health.

Ready to tackle Diabetes head on?

DON’T WAIT. The longer you put it off, the greater the challenge will be to get your fitness back.

At Movement for Life Physiotherapy, we can screen you for health issues related to diabetes. We will run you through a series of progressive exercise tests to find out what you can do, and tailor your diabetes management plan to exactly what you need. And we have options for you - from home exercise programs, to hydrotherapy, group exercise, even gym programs.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

Resources

Lower Leg - Shin Splints

Thu, 16 Jun 2022 08:44:06 GMT

Getting back into running and got shin pain? You're not alone.

Shin pain, and in particular shin splints, is a common presentation to physio clinics. It’s an overuse injury of the lower extremity, often seen in athletes and defence force personnel. In simple terms, shin splints is pain over the anterior tibia that comes on with exercise and is an early stress injury in the continuum of tibial stress fractures ^1,2,4,6,7 .

First up, let’s get this out of the way. Most people (and even plenty of medical people) refer to pain in the shins as shin splints.

The term came about because the area of discomfort is the shinbone, or tibia, and some (but not all) of the symptoms can be sharp and stabbing. It’s not a particularly accurate name though, and doesn’t tell us anything about the actual injury, the process that is going on, or how to fix it. And it conjures up thoughts of either the bone underneath splintering, or of having to have you leg in a splint, both of which could ‘kind of’ happen, but let’s not get ahead of ourselves.

What is it really?

A more accurate name for shin splints, is medial tibial stress syndrome, or MTSS. While this is a little harder to remember, it is a much more descriptive and accurate term for the injury. Essentially, when we have “Shin Splints”, there is a stress response happening along the medial border of the tibia. This stress response is sufficient to irritate the nerve endings in the bone and wham, we get shin pain.

A little bit of anatomy

To understand the how and why behind MTSS, let’s look at the underlying anatomy. First up, the lower leg houses a lot (and I mean a lot!) of muscles, nerves, and blood vessels. These are arranged into compartments – essentially bundles of muscles enclosed in a fibrous fascial layer. And these muscles and the outer fascial layers attach to the bone. Click here to see what we mean.

Active muscle stresses bone

When we exercise, the contracting muscles, anchored strongly to the bone, produce movement and stability at the ankle and foot. They also need extra oxygen and so our heart pumps more blood into the region. This increases the volume of blood in the compartments, straining the fascia. Combined with the pull effect of the muscles, this increases the stress on the bony attachment (periosteum) causing microtrauma ^3,4 .

This microtrauma is a normal part of exercise and a key part of how our skeleton adapts and gets stronger in response to exercise. If, between exercise bouts, we give our bodies enough time to recover and repair, then the microtrauma to our shins can recover. If we don’t, the microtrauma accumulates, eventually eliciting a pain response and bingo, we have MTSS!

More than just load

So, MTSS is an issue of load, or more accurately, a lack of recovery. So why do some people get it, and others don’t?

The reasons are multifactorial. Some people have naturally tighter compartments, exposing the tibia to stress load earlier. Other people have tightness or weakness in certain muscles, which impacts the development of shin pain. Biomechanics such as foot posture or lower limb valgus can impact forces through the lower leg, while training age (ie. the total training time/ experience the athlete has in that aspect of physical training) and training volumes also play a role ^3,4 . In our younger athletes, skeletal maturity is an important consideration, remembering that kids bones mature at very different rates.

Who gets it?

MTSS is more common in sporting populations, particularly those requiring a lot of running, jumping and change of direction ^1,4,5 . So people involved in basketball, hockey, athletics, netball, soccer and AFL are all susceptible to MTSS. If you’re female, have increased BMI, higher navicular drop, previous running injury, and/or greater hip external rotation with the hip in flexion, you have a higher risk of developing MTSS ^3,5,6,7 .

And you don’t need to be an elite athlete. In many instances, MTSS presents in people playing social sport, those returning to sport after a break or those just trying to increase their general fitness through running ³ .

Diagnosing MTSS

In most instances, diagnosing MTSS is relatively straight forward. A thorough understanding of the volume and type of exposure to load, both recently and in the past, combined with reported symptoms and location of pain are usually enough to make a diagnosis of MTSS ^3,4 .

Biomechanical assessment is important to identify the factors that might be contributing to MTSS. Running and walking patterns, foot posture, hip, knee, and trunk control are all important assessments in the presence of MTSS. Individual muscle groups of the lower leg should also be assessed for strength and tightness ^6,7 .

In some instances, medical imaging is indicated, particularly if symptoms have persisted for long periods of time or if pain is not settling with rest ^3,4 . Keep in mind that MTSS is a continuum of a bony stress response, so there are varying degrees of injury associated with it.

Any red flags?

There are a couple of important diagnostic considerations with pain in this area, notably compartment syndrome, popliteal artery entrapment, and osteosarcoma. While these are less common, they need to be excluded in a thorough assessment ² . Chronic persistent MTSS can progress to a stress fracture and even a full tibial fracture, in which case you just might need that splint, so best see your health professional for assessment and management.

Management of MTSS

Management of MTSS needs to address the load/recovery issues as well as the biomechanical and soft tissue contributions to symptoms ² .

Addressing load and recovery issues is critical. This usually requires a reduction in load exposure and modification of activity. Some sessions might need to be substituted with other activities such as swimming or cycling, maintaining cardio fitness while letting the injury recover. Logging exercise sessions for duration and intensity alongside pain experiences can be valuable for identifying activity patterns contributing to MTSS.

Meanwhile, physiotherapy will help with biomechanical issues, running gait, reducing muscle tightness, improving joint mobility, taping techniques (eg. low dye taping for flat foot) and progressive strengthening programs.

The Take Home

MTSS is a modifiable injury that generally makes a full recovery over a 3-6 month period ³ . People respond well to load reduction, strengthening and stretching exercises, and gait re-education, allowing for a gradual return to sport and activity as symptoms subside. Having a structured plan from a physiotherapist that combines treatment of biomechanical issues with load and recovery management is integral to a successful outcome and reducing the risk of future episodes of MTSS.

Got shin pain when you exercise and think it might be shin splints? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your shin pain and let you know whether you do have shin splints or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Becker J, Nakajima M and Wu W (2018) Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Medicine and Science in Sports and Exercise, 50(10), 2092-2100, DOI: 10.1249/mss.0000000000001674
Medial Tibial Stress Syndrome. Accessed at https://www.physio-pedia.com/Medial_Tibial_Stress_Syndrome
Menéndez C, Batalla L, Prieto A, Rodríguez MA , Crespo I and Olmedillas H (2020). Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. International Journal of Environmental Research and Public Health, 17, 7457, DOI: 10.3390/ijerph17207457.
Moen MH, Tol JL, Weir A, Steunebrink M and De Winter TC (2009) Medial Tibial Stress Syndrome: A Critical Review. Sports Medicine, 39 (7), 523-546.
Newman P, Witchalls J, Waddington G and Adams R (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873798/pdf/oajsm-4-229.pdf
Reinking MF, Austin TM, Richter RR and Krieger MM (2017). Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Physical Therapy, DOI: 10.1177/1941738116673299
Winkelmann ZK, Anderson D, Games KE and Eberman LE (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training, 51(12), 1049–1052, DOI: 10.4085/1062-6050-51.12.13

NDIS - Exercising with Multiple Sclerosis

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 15 Jun 2022 03:01:38 GMT

MS is a complex disease, but physiotherapy-led exercise can help

Multiple Sclerosis, or MS, is a progressive neurological disorder that affects approximately 25,600 people in Australia and over 2.8 million people worldwide ⁷ . Over the past 20 years, there have been significant advances in disease-modifying medications and recent years have heralded a revolution in treatment options. Despite this, many people with MS (PwMS) continue to live with disability. Targeted interventions, including physiotherapy and therapeutic exercise, to address individual symptoms remain a critical aspect of managing PwMS.

In Australia, the introduction of the NDIS is improving access to physiotherapy and a broader range of therapy options, including therapeutic exercise, hydrotherapy and telehealth delivered exercise in the home.

Some facts about MS

MS is a complex, multi-factorial neurological condition that affects the myelin sheath around nerves in the central nervous system (CNS) ^6,10 . To put this in layman terms, each nerve has an insulating cover called myelin, much like an electrical wire in our house. In MS, the myelin sheath starts to break down, causing interruptions in the transmission of signals.

The cause of MS is not clear however it is understood that there are environmental, behavioural, and genetic factors implicated in its aetiology and clinical course. Importantly, people with MS have a normal life expectancy, which means they may live for many years with severe mobility issues and a need for regular therapeutic intervention ⁴ . Click here for more facts on MS in Australia.

What are the symptoms?

There are no typical symptoms of MS and what one person experiences may not be experienced by another person ¹⁰ . Because MS is a progressive neurodegenerative disease, it does result in a wide spectrum of disorders in functional systems including motor, sensory, visual, psychological, sexual, and bowel and bladder function ⁴ .

Many people first notice visual disturbances as an early sign. This is often accompanied by fatigue, pain in the back of the eyes, numbness, and tingling sensations. As MS progresses, people notice motor issues, such as a loss of balance, dizziness and reduced functional capacity ^8,10 .

It is important to remember that many of these symptoms can be caused by other conditions as well.

Don’t assume your symptoms are a sign of MS though - not everyone who experiences them will get an MS diagnosis.

That’s why it is important to consult your GP if you have any symptoms that are worrying you.

How is MS diagnosed?

MS is a complex disease with a wide spectrum of symptoms. In most instances, where MS is suspected, your GP will refer you for various blood tests and scans and for assessment by a Neurologist. Investigations can include an MRI, lumbar puncture (looking for antibodies that might not normally be present), blood tests and nerve conduction studies.

Once a diagnosis of MS is made, people are often assessed against a scale called the Expanded Disability Status Scale (EDSS). This is a way of measuring how much someone is affected by their MS and guiding appropriate interventions and needs at the time.

Where does Physiotherapy fit in?

Physiotherapy is a core part of a multi-disciplinary approach to managing People with Multiple Sclerosis ⁴ (PwMS) and co-morbidity risks associated with reduce physical activity ^4,5 . MS is progressive and characterised by ‘relapses’, so the needs and goals of the patient will vary over the lifespan. Physiotherapists are great at assessing current symptoms, formulating patient-centred goals, and delivering therapeutic interventions to reduce pain and enhance the autonomy, strength, and coordination of voluntary movements ⁴ .

For the PwMS, acute issues might be pain, loss of balance, spasticity, or a specific functional limitation. Physiotherapy can help address these, with a long-term view of facilitating the participation needs of the client, educating clients and families, improving physical independence and fitness levels, reducing persistent pain, and improving quality of life across the lifespan ^4,5 .

Exercise

There is a significant body of evidence to suggest that, for those living with MS who remain ambulatory, exercise programs can have a beneficial effect on both disease symptoms and general fitness ^4,5,6 . Aerobic exercise has been shown to improve walking speed and step length, and reduce fatigue, while progressive resistance exercise programs improve walking over short distances, improve physical strength and balance, reduce fatigue, and improve quality of life ^4,5,6,8 .

There is also mounting evidence that exercise programs delivered by physiotherapists via telehealth to PwMS can be as effective as programs delivered face to face, and that even exercise games can be beneficial in achieving the fitness goals for PwMS ³ .

LEAP-MS

LEAP-MS stands for ‘Lifestyle, Exercise and Activity Package for people with MS’, and is a new study being conducted out of Cardiff University in the UK. The aim of the study is to help physiotherapists identify barriers that PwMS face with keeping active and to develop a platform to assist in the delivery of programs that will improve physical fitness and quality of life in PwMS ⁵ . Click here for more information.

Pain Management

Physiotherapy can assist with pain associated with relapses using a variety of techniques. Soft tissue therapy, joint mobilisation, and hydrotherapy can greatly assist with reducing the pain experience. Smart adjustments to exercise programs during a flare-up can also help reduce pain and manage fatigue.

The Take Home

Physiotherapy will make a huge contribution to the quality of life and functional capacity of clients with MS both during relapses and across the lifespan. In Australia, the NDIS has increased access to services for persons with MS. The evidence is strong for a variety of physiotherapy led interventions, particularly functional therapeutic exercise and pain management, which can be adapted to address acute symptoms and tailored to meet the long-term goals of the individual PwMS.

Do you want to get more out of your NDIS funding? Then give us a call.

All our clients are individually assessed, and programs tailored to your specific needs. We are the only QIP Accredited Physiotherapy services in the Northern Territory and an approved NDIS provider. We offer a broad range of services to assist with management of neurological movement disorders and persistent pain including hydrotherapy, manual therapy, massage, therapeutic exercise programs, clinical pilates and functional rehabilitation, all delivered by a highly skilled team.

References

Amiri Z, Sekhavat Y, Goljaryan S & Roohi S (2022). KeepStep: Accommodating user diversity through individualized, projection-mapping based exergames for rehabilitation in people with multiple sclerosis. Multimedia Tools and Applications, https://doi.org/10.1007/s11042-022-12771-w
Campbell JA, Simpson Jr S, Ahmad H, Taylor BV, van der Mei I and Palmer AJ (2019). Change in multiple sclerosis prevalence over time in Australia 2010–2017 utilising disease modifying therapy prescription data. Multiple Sclerosis Journal, https://doi.org/10.1177/1352458519861270
Chanpimol S, Benson K, Maloni, H, Conroy S & Wallin M (2020). Acceptability and outcomes of an individualized exergaming telePT program for veterans with multiple sclerosis: a pilot study. Archives of Physiotherapy, 10:18, https://doi.org/10.1186/s40945-020-00089-5
Coote S, Garrett M, Hogan N, Larkin A & Saunders J (2009). Getting the Balance Right: A randomised controlled trial of physiotherapy and Exercise Interventions for ambulatory people with multiple sclerosis. BMC Neurology 2009, 9:34 doi:10.1186/1471-2377-9-34
Latchem-Hastings J, Randell E, Button K, Jones F, Lowe R, Dawes H, Wood F, Davies F, Poile V, O’Halloran R, Stensland B, Tallantyre E, Playle R, Edwards A & Busse M (2021). Lifestyle, exercise and activity package for people living with progressive multiple sclerosis (LEAP-MS): protocol for a singlearm feasibility study. Pilot and Feasibility Studies, 7:111, https://doi.org/10.1186/s40814-021-00852-w
Motl RW & Sandroff BM (2015). Benefits of Exercise Training in Multiple Sclerosis. Curr Neurol Neurosci Rep, 15: 62, DOI 10.1007/s11910-015-0585-6
Proschinger S, Kuhwand P, Rademacher A, Walzik D, Warnke C, Zimmer P & Joisten N (2022). Fitness, physical activity, and exercise in multiple sclerosis: a systematic review on current evidence for interactions with disease activity and progression, Journal of Neurology, 269:2922–2940, https://doi.org/10.1007/s00415-021-10935-6
Sattelmayer KM , Chevalley O, Kool J, Wiskerke E, Denkinger LN, Giacomino K, Opsommer E & Hilfiker R (2021). Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis. Archives of Physiotherapy, 11:29, https://doi.org/10.1186/s40945-021-00120-3
Sedel L, Wilson IB & McDonald EA (2014). Current management of relapsing-remitting multiple sclerosis, Internal Medicine Journal, doi:10.1111/imj.12558.
Seebacher B, Kuisma R, Glynn A & Berger T (2018). Exploring cued and non-cued motor imagery interventions in people with multiple sclerosis: a randomised feasibility trial and reliability study. Archives of Physiotherapy, 8:6, https://doi.org/10.1186/s40945-018-0045-0

Tennis Elbow

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 19 May 2022 02:43:02 GMT

When it comes to treating lateral elbow pain, one size does not fit all.

Tennis elbow (or if you want to be really nerdy, lateral elbow tendinopathy or lateral epicondylalgia) is a common musculoskeletal presentation affecting approximately 1-3% of the population. Characterized by pain when gripping or lifting objects with the palm down, you do not need to be a tennis player or even have played tennis to get tennis elbow. In fact, tasks as light as sewing or typing can result in tennis elbow.

TOP TIP: Don’t rely on stock exercise programs and treatment remedies. Tennis elbow is a complex injury that needs an individualized management plan from your physiotherapist to get better. Read on to find out why.

Nuts and Bolts

On the outside of the elbow there is a boney prominence call the lateral epicondyle. It is from here that our 5 wrist and finger extensor muscles originate from a common tendon, before separating out to become individual muscles distally.

The main culprit in tennis elbow is thought to be one of our wrist extensors, called extensor carpi radialis brevis. As a result of repeated exposure to wrist extension and gripping activities, the tendon fibers begin to break down. Under normal circumstances, with adequate time to recover, these fibers repair and develop greater tensile resistance. Ie. they get stronger. However, if the tendons are repeatedly exposed to load without adequate time to recover, fiber disruption is compounded, resulting in changes to the tendon structure, irritation of local nerve endings, pain, and restricted function.

Risk Factors and Injury Prevention

There is a lot about tennis elbow that we don’t know, particularly why some people seem to develop it, while others doing the same type of activity don’t. From studies on tendon injuries in general though, we know that there are intrinsic and extrinsic risk factors for developing tendon pathology. Intrinsic risk factors include age (35-54 years old is the highest risk), sex, body weight, diabetes, rheumatologic diseases, and a history of smoking. Extrinsic factors include mostly sports and occupational related activities.

Transitioning into a new work role where you type 8 hours a day will increase your risk, as will practicing your backhand top spin daily for 3 weeks straight – it’s not called tennis elbow for nothing.

Injury prevention comes down to the ability to identify these risk factors and put them into context. In the workplace, this is important, as many people in the higher risk age bracket are transitioning into new roles or returning to the workplace after having children. Identifying risk factors can reduce injury risk, reducing time lost to injury and reducing the economic burden on workplaces and health care systems.

Is it Tennis Elbow?

Lateral elbow pain can have many causes, so don’t assume that just because you have elbow pain you have tennis elbow!

Tennis elbow is a spectrum of disease, ranging from isolated local tendon damage, through to complex, multi-system (tendon, joint, nerve), and multi-area (elbow, wrist, shoulder and neck) presentations. The duration, location and severity of symptoms will guide the type of intervention recommended, as will the number of episodes of tennis elbow experienced in a lifetime.

Diagnosing tennis elbow is simple and quick. Most physiotherapists can do this with 3 straight forward tests, though other tests are essential to identify or exclude other potential sources or reasons for symptoms. Medical imaging (xray, ultrasound, MRI) is not usually required to make a diagnosis of tennis elbow, and referral to an orthopaedic surgeon is not usually indicated initially.

Managing Tennis Elbow

Once a diagnosis of tennis elbow is made, the challenge is to work out what is happening in the tendon. Understanding the cause of the injury, the phase of the injury (particularly if the tendon is in a reactive or degenerative phase) and issues contributing to symptoms is challenging, and it is these factors that will determine the type and style of rehabilitation you need.

Exercise plays a critical role in the management of tennis elbow. The volume, load and type of exercise will be guided by many factors, including the phase of the injury and co-existing biomechanical problems – think shoulder and neck issues. Manual therapy (joint mobilization, soft tissue therapy, stretches), hot and cold therapy, and taping/braces can play an important role in relieving pain. These interventions are non-invasive, cheap and have minimal side effects.

What about Autologous Tenocyte Implantation (ATI)?

There is often a lot of hype when there is a new treatment approach floated, particularly for a condition like tennis elbow that can be difficult to manage. While there is some evidence that ATI can be beneficial in reducing pain associated with severe, persistent (greater than 12 months) cases, the research remains inconclusive as to the long term benefits above and beyond conservative management. Currently the cost for ATI is anywhere between $7,500 and $20,000, and it doesn't get you out of modifying your activity or doing your rehab!

The truth is, for the majority of people, physiotherapy-led education and guidance on load management are all that’s required. In fact, many high quality studies have shown that 83%-90% of people have significant improvement with a wait-and-see approach. However, up to 33% of people experience symptoms lasting greater than 12 months and many people report recurrent symptoms following the initial episode. So be patient, stay in touch with your physiotherapist, and be diligent with your rehab program. For more info on evidence-based management of tennis elbow, click here .

The Take Home

Tennis elbow is a complex spectrum of disease that requires treatment and exercises tailored to the pathology and clinical presentation of the condition. Applying a “one size fits all” approach is unlikely to be effective, prolonging symptoms and resulting in extended time away from work, sport and social activities. Early physiotherapy intervention and education will greatly benefit people with lateral elbow pain, improving outcomes and reducing time lost to work and sport.

Do you have lateral elbow pain and think it might be tennis elbow? Give us a call now.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your elbow pain and let you know whether you do have tennis elbow or if there is something else going on. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References

Bateman et al (2021). Development of an optimized physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique. British Medical Journal.
Bisset et al. (2007). Conservative treatments for tennis elbow—do subgroups of patients respond differently? Rheumatology
Coombes et al. (2015). Management of lateral elbow tendinopathy: One size does not fit all. Journal of Sports Physical Therapy
Day et al. (2019). A comprehensive rehabilitation program for treating lateral elbow tendinopathy. The International Journal of Sports Physical Therapy
Stasinopoulos (2022). Stop using the eccentric exercises as the gold standard treatment for the management of lateral elbow tendinopathy. Journal of Clinical Medicine
Tennis Elbow: What Is It? How Do I Get Back to My Regular Activities? Journal of Orthopaedic & Sports Physical Therapy 2023 53:4, 1-1
Wang and Thampatty (2021). The pathogenic mechanics of tendinopathy. In: Tendinopathy, pp13-22.

Could your foot pain be a Lisfranc injury?

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 17 May 2022 06:50:25 GMT

A simple mid-foot sprain could be a Lisfranc injury

Lisfranc injuries are a complex injury involving the bones and joints of the midfoot and their associated ligaments. The term ‘Lisfranc injury’ covers a spectrum of injury, including ligament rupture, joint dislocation, and fracture, with many cases requiring surgery and greater periods of non-weightbearing management. While they only represent 0.2% of all fractures, almost 20% of Lisfranc injuries are initially missed.

Whilst complex, if diagnosed early and accurately, recovery outcomes from Lisfranc injuries are usually successful.

A little bit of anatomy

There’s no avoiding it. If you want to understand this injury and why the rehab is so important, you will need to understand the anatomy first.

Click her e to get a better understanding of the bones and ligaments of the foot and here to see the structures that are damaged in a Lisfranc dislocation. This short YouTube clip also provides a great overview of the Lisfranc ligament and injury.

Lisfranc injuries involve the tarsometatarsal (TMT) joints in the midfoot, most commonly the first and second joints. The foot has long bones (the metatarsals) that articulate with a group of tarsal bones (the navicular, cuneiform and cuboid), that allow the foot to accommodate to different surfaces and positions. These joints are supported by various ligaments to provide soft tissue stability.

The TMT joints are important weight bearing structures. We are reliant on the stability of these structures to develop tension in the midfoot, allowing us to power forward in walking, running and weightbearing tasks. Lisfranc injuries always involve injury to the Lisfranc ligament, whether that be a sprain or a rupture, and variably the tarsometatarsal joints. This impacts joint stability and foot structure, which, if not managed well, can have profound long-term consequences for weight bearing activities and result in chronic pain.

The Injury

A Lisfranc injury can result from direct or indirect trauma. Direct trauma is when something is dropped on the foot resulting in dislocation of the joint towards the sole of the foot. Indirect trauma usually results from a combined compression and external rotation force to the foot, such as might occur when a person stumbles over the top of a plantarflexed foot. These can be low-energy mishaps without a clear mechanism of injury, adding to the diagnostic challenge.

Lisfranc injuries are more common in soccer players, gymnasts and dancers, from falls (such as down stairs), and in car accidents, where an axial load can be forcefully applied to the foot suddenly. Injury can result in ligament rupture, fractures or joint dislocation, or all three, and can occur in isolation or in multiple areas of the midfoot. This short 5 min YouTube clip provides further information on the spectrum of injury that can occur with a Lisfranc injury.

Injury Management

Diagnosing a Lisfranc injury can be complex. A thorough history, including detail on the mechanism of injury is critical. Symptoms may include pain on weightbearing, pain on palpation along the tarsometatarsal joints and pain with certain movements. Bruising on the sole of the foot is suggestive of Lisfranc ligament injury. In less severe cases though the mechanism of injury may not be obvious, there may be minimal swelling or bruising present and only intermittent, vague pain reported.

Radiological investigation is indicated to diagnose fractures and determine if there is any widening of joint spaces. In subtle injuries or cases of multiple fractures and dislocations, CT scan may be required to diagnose the injury and/or plan surgical management.

Referral to an orthopaedic surgeon is required. Surgery is required in most cases, involving open reduction and internal fixation of fractures and stabilisation of affected joints to permit appropriate healing. Surgically managed cases are usually immobilised for a period or 8-12 weeks, while non-surgically managed injuries will require immobilisation in a moon boot for up to 6 weeks.

Physiotherapy should commence as soon as the injury is diagnosed. Even while immobilised, physiotherapy can assist with reduction of swelling, managing with crutches, strength and flexibility. As the rehabilitation process continues, physiotherapy will assist with general fitness (think swimming, cycling and eventually walking), regaining ankle and foot range of motion, load management and prescription of foot orthotics.

A key point to understand with a Lisfranc injury is that the prognosis (ie. the likelihood of a good outcome) is NOT dependent on the extent on the injury.

Even minor Lisfranc injuries, with only a small degree of joint displacement, can result in early onset post-traumatic arthritis of the area and significantly impact future functional capacity. For this reason, even minor Lisfranc injuries may require surgical intervention to reduce the risk of later complications.

The Take Home

Lisfranc injury is a somewhat rare, complex injury that can have significant complications if not managed well and respected by the owner. It is more common in sporting populations and dancers where the mechanisms of injuries are more frequently encountered. Early assessment and diagnosis and appropriate management is important in ensuring a good outcome and return to normal function in the short and long term.

What now?

If you've hurt your foot, or have persistent foot pain, give us a call NOW.

At Movement for Life Physiotherapy, we can diagnose the cause of your foot pain and guide you through the process of getting further investigations and help. We know the best surgeons in town and can point you in the right direction to ensure you make the best recovery.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References:

Harwood & Raikin (2003). A lisfranc fracture-dislocation in a football player. Journal of the American Board of Family Practice
Moracia-Ochagavia & Rodriguez-Merchan (2019). Lisfranc fracture-dislocations: Current management. EFORT Open Reviews
Yan et al (2021). Updates on Lisfranc complex injuries, American Orthopaedic Foot and Ankle Society

Sports Massage

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 08 Mar 2022 08:41:58 GMT

If you play sport or work out, you need a good massage therapist

Sports physiotherapists often breathe a sign of relief when they know they have a massage therapist on the team. And for good reason. Sports massage plays an important role in treating and managing soft tissue injuries as well as prevention of future injury (and they save the physio’s hands!). There’s a good reason massage therapists are permanent fixture in Australian Olympic teams.

What is Sports Massage?

Sports massage is a therapeutic approach that utilizes a variety of massage techniques to treat and prevent soft tissue injuries. The type of massage technique used during a sports massage varies depending on the individual, the area to be treated and the desired outcome. Some of the techniques used are:

1. Soft Tissue Massage

This is so much more than just a massage. It is a targeted technique that aims to reduce tension and pain in the muscles and joints through effects on:

Muscles, tendons, and ligaments
Superficial fascia
Fluids such as blood, lymph and interstitial fluid (the fluid between cells)
Arteries, veins, lymph nodes and lymph channels.
Nerves and motor programs (brain maps that direct movement/ dysfunctional patterns)

2. Deep Tissue Massage

As the name suggests, deep tissue massage focuses on the deeper layers of muscle and fascia and are more commonly used during injury management or recovery sessions. Deep tissue massage is usually more uncomfortable (what we call “good pain”) as the therapist uses slower, sustained pressure on areas to assist in releasing tight structures and trigger points. These techniques can have far reaching effects and an ultimately soothing effect.

3. Whole body massage

Between exercise bouts and games, a relaxing whole-body massage can be used to help loosen tight muscles and calm the body and mind. Techniques such as Swedish massage that utilize effleurage and long strokes over the legs, back and arms can assist physical and mental recovery, improving sleep and next day performance.

How does sports massage work?

Every time we exercise, there is microscopic break down or damage of tissue. This is a normal process, and the body responds by repairing the damaged tissue and adapting it to better suit the conditions. This is how our muscles, tendons and joints develop tolerance to load and get stronger.

If we are doing repeated bouts of exercise, for example every second day or on consecutive days, there can be inadequate time to allow for the tissues to recover. This can present as delayed onset muscle soreness (DOMS), muscle and joint tightness, and reduced performance.

Sports massage works by stretching and stimulating tight muscles, transiently increasing blood flow to the region, and stimulating the nerves in the area. This has been shown to reduce perceived muscle pain and improve strength and power. After the acute phase of injury, sports massage can assist with reducing muscle tightness, reduce formation of scar tissue, dispersing inflammatory markers and reducing pain.

Regular massage before and after strenuous exercise can warm up and prepare muscles for activity. It can also facilitate recovery and long-term conditioning by modulating overactive and inactive soft tissues, as well as reducing fatigue and injury risk.

Who is it for?

While nearly every leading sport organisation employs massage therapists, sports massage is not reserved for just the elite. Amateur and weekend athletes and those leading an active lifestyle will all benefit from sports massage. Using a variety of massage techniques, sports massage is an effective adjunct treatment to increase flexibility, prevent injuries, and treat existing injuries or strains, assisting in recovery and rehabilitation and helping individual athletes and teams perform at their best.

The Take Home

Sports massage is a non-invasive, economical way to manage muscle soreness, improve exercise performance, and reduce injury risk. As part of a multi-disciplinary approach, it forms an important part of the rehabilitation and recovery process post injury. Good Sports Physiotherapists know the value of a good Sports Massage Therapist and will work closely with them to help athletes achieve their best.

If you're looking for a Sports Massage therapist, then give us a call.

We have a fully qualified, experienced soft tissue massage therapist on staff who works closely with our physiotherapists.

Give us a call on 08 8945 3799 or Book Online now.

Osteoporosis

Tue, 08 Mar 2022 03:13:00 GMT

Reducing your falls risk is a key part of managing osteoporosis

Osteoporosis is a common bone condition that is characterized by reduced bone mass resulting in thin, weak and fragile bones. Osteoporosis is associated with a higher risk of fractures resulting from low-velocity or low-trauma accidents, which in healthy populations would not usually occur (e.g. from a fall, a bump, or even from coughing). Click here to have a look at the anatomy behind osteoporosis.

Osteoporotic clients who suffer a hip or vertebral fracture from a fall have a shorter life expectancy. This happens because the fracture, combined with other underlying health conditions, often results in significant deconditioning, loss of independence and further health complications. So it is well worth treating and, where possible, preventing.

Who it affects

In Australia, Osteoporosis affects an estimated 924,000 people, representing about 3.8% of the population. This condition is more commonly seen in women than men and affects 1 in 4 women over the age of 75. It has an increased likelihood with age and is influenced by lifestyle factors including alcohol intake, diet, smoking status and physical activity levels.

How Osteoporosis is diagnosed

Osteoporosis is a silent condition, one that many people are not aware of until they have a fall resulting in a fractured wrist, hip, or vertebra. Most people who are at high risk of osteoporosis are not screened for it, and up to 60% of people are not aware of their falls risk. See more facts on osteoporosis here.

If you think you have Osteoporosis, visiting your local GP is a good place to start. Your GP will be able to order various tests that measure your Bone Mineral Density - literally how dense your bones are. The most commonly used scan is a dual-energy X-ray absorptiometry scan (DEXA Scan), which measures the bone density of your hips and vertebrae of your spine. Results from these tests are graded against the general population for comparison. A diagnosis of osteoporosis means you have lost bone mass and that the bones are essentially more porous. Click here to see what this looks like microscopically.

How Osteoporosis is treated

Management of osteoporosis needs to be multi-disciplinary and individualized to ensure that the client is central in their health care decisions. Your GP, a specialist, physiotherapist and dietician are central to helping you live with osteoporosis. Personal goal setting is essential and should include strategies to prevent ‘fragility’ fractures and improve lifestyle outcomes.

Pharmacological Interventions

There are a range of medications and injections available to improve bone mineral density. They reduce the speed of bone turnover and can assist or ‘kick-start’ bone formation. Bisphosphonates, raloxifene and Hormone Replacement Therapy are common forms of medications to reduce the rate of bone turnover, while anabolic medications stimulate bone formation.

Therapeutic Exercise

Exercise interventions help manage osteoporosis and fractures sustained from low trauma in two main ways. Firstly, increased physical activity that loads bones and joints stimulates bone formation to maintain and improve their density. Secondly, when implemented in a falls prevention program, exercise prescription reduces the risk of low-trauma accidents, such as a fall, thereby reducing the risk of fragility fractures.

Diet

Diet is another important consideration in the management of Osteoporosis, however there is not a great deal of robust evidence out there supporting one diet over another. Whilst this is the case, the importance of following a well-balanced diet under the current Government dietary recommendations cannot be overstated.

Physiotherapy Management of Osteoporosis

Physiotherapists are well equipped to manage osteoporosis and prevent fragility fractures. Individualized programs can be set up during an initial consultation and outcome measures related to strength, mobility and falls risk are taken as baselines to measure progress against.

There is high quality evidence that shows a combination of exercise types is best to help reduce risk of fractures caused by falls. These exercises include balance training, flexibility, endurance and progressive strengthening exercises. Integration of these exercises into a group exercise class is a fantastic way to be monitored and continue to be challenged where improvements are made. A General Exercise group that challenges your balance and agility, and focuses on high intensity strengthening is a great place to start, all of which has excellent evidence behind it for managing osteoporosis.

Upcoming Research

Exciting research out of Griffith University on the Gold Coast is looking into further treatment options for the management of Osteoporosis. Originally hoping to start in 2019, they have been hit with multiple COVID-19 related setbacks. The study will investigate the effects of Whole Body Vibration (WBV) as a novel treatment option of Osteoporosis. It will compare WBV with and without exercise therapy to see if there is a significant benefit of adding vibrations to the mix of a management program. Keep an eye out for updates and head to this link for further information.

Resources

Pelvis - Sacroiliac Joint (SIJ) Pain

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 03 Mar 2022 12:43:14 GMT

Back pain rolling over at night or going up stairs? It could be your SIJ.

The sacroiliac joint is located between your pelvic bones and sacrum, which sits at the base of the spine. It is an important joint which helps to maintain our pelvic stability and enables us to stand up straight, walk and run. It is also a source of pain for many people throughout our lives. This pain can keep us out of sport, reduce our ability to exercise and stop us from doing the things we love.

Anatomy 101

When it comes to the SIJ, we’re talking big, strong bones, joints and muscles, with lots of supporting ligaments. Best to get a glimpse of this from a picture. Click here to explore the anatomy of the SIJ a little more.

So, who gets SIJ pain?

It is estimated that between 75% and 84% of people will experience an episode of non-specific (common) low back pain at some point in their lives ^1,2,3 , and that of these, 25% may originate from the sacroiliac joint ² . This makes it a common cause of low back pain.

People can develop SIJ from several different causes including ² :

A fall
Motor vehicle accidents
Repetitive stress e.g. playing golf
Arthritis or other inflammatory conditions
Pregnancy
Leg length discrepancy
Scoliosis

Statistically there are two age groups most at risk of developing SIJ pain – younger adults with sporting injuries and/or pregnancy, and older adults with joint degeneration e.g. arthritis ² .

How do I know if I have SIJ pain?

Diagnosing the SIJ as the source of pain can be tricky. It often masquerades as low back, hip or pelvic pain. Symptoms can be quite vague and intermittent. Generally speaking SIJ pain presents with a number of key symptoms that physiotherapists are trained to assess for. Some of these include:

History of a fall, car accident or incident which brought on symptoms of SIJ pain

Onset of pain over the later stages of a pregnancy
Pain with certain activities such as sitting, lying down or walking up stairs
Excluding other areas such as the lower back and hip joint

I think I have SIJ pain. What do I do next?

SIJ pain can be managed successfully with physiotherapy and a graded, therapeutic exercise program. A thorough assessment is key. Physiotherapists will look for asymmetries with movement, tightness in key muscle groups, and reproduction of pain with certain activities. Treatment will be different for every person, and can include soft tissue work, dry needling, joint mobilisation, taping techniques and supportive belts.

A tailored exercise program focusing on strengthening and improving control of key muscles and movements is imperative. Core stability strengthening is generally indicated, and clinical pilates can be a great way to develop this control. Hydrotherapy (therapeutic exercise in a temperature-controlled pool) can be of huge benefit in acute cases and those experiencing SIJ pain throughout pregnancy. It’s a fantastic way to get a good workout without exacerbating pain. For more information on these, check out our blog on antenatal hydrotherapy.

The Take Home

The vast majority of SIJ pain can be well managed with a period of physiotherapy treatment and a well-designed exercise program. Addressing asymmetries in movement and muscle tone can assist in reducing pain, while targeted exercises that help restore and control movement patterns across the pelvis will assist greatly with longer term symptom management.

Keep in contact with your physiotherapist. When it comes to muscles, joints and fitness, they are the key medical professional. A simple check-up to monitor your trunk strength, range of motion and functional control against baseline measures and adjust an exercise program will help keep you active for longer and your body happier and healthier.

Do you have low back or SIJ pain?

Are you pregnant or been recently been diagnosed with osteoarthritis?

Give us a call. We love the SIJ and we love helping people with all sorts of joint problems get back to doing what they enjoy most.

References

Thiese et al (2014). Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskeletal Disorders, 15, 283-294.
Australian Institute of Health and Welfare 2019. Back problems. Cat. no. PHE 231. Canberra: AIHW. Viewed 22 April 2020, https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems
Raj MA, Ampat G, Varacallo M. Sacroiliac Joint Pain. [Updated 2021 Nov 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470299/

Hamstring Strain

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 03 Mar 2022 00:44:31 GMT

Hamstring injuries happen. How we manage them is the key.

If you have ever done a ‘hammy’, as it is known in Aussie sporting vernacular, then you’ll know the combination of instantaneous grabbing, anguish and pain that accompanies them. For Aussie rules and English premier league fans, they are a weekly occurrence, changing a player and their club’s prospects in an instant and, in some instances, their season or career.

Hamstring muscle strains are common injuries in sports that require maximum sprinting, kicking, acceleration, and change of direction. The injury mechanism has been called the “high-speed running” mechanism. A second injury type has also been described as a “stretch” injury. This occurs during movements leading to extensive lengthening of the hamstrings, such as high kicking, sliding tackles and sideways splits. The distinction is important to make as the “stretch” injury may have a more prolonged recovery ¹ .

Nuts and Bolts

The hamstrings are a group of 3 muscles located in the back part of the thigh. They originate at the pelvis, cross the back of the hip joint and span the entire length of the thigh to insert just below the knee. Two of them insert on the inside of the knee while one, biceps femoris, inserts on the outside of the knee. Click here to see how to palpate the distal hamstring tendons and click here to take a peek at the anatomy.

Because they cross both the hip AND the knee joint the hamstrings are referred to as a two joint muscle and is one reason they are particularly susceptible to strain injury.

Risk Factors and Injury Prevention

By far the greatest risk factor for a hamstring strain in the future is a past history of a hamstring injury. Football players with a previous hamstring injury have a seven-times higher risk of injury than players with no injury history ² . On average, repeat injuries also result in a 30% longer absence from football ³ . Other risk factors for hamstring strain are older age and increased peak quadriceps torque ⁶ . The latter basically means the hamstring is working against a greater opposing force.

According to numerous recent studies, almost two-thirds of hamstring injuries might be prevented by increasing eccentric strength of the hamstring (muscle lengthening). One of the more popularised modalities of eccentric strengthening is the Nordic hamstring exercise ⁴ . This exercise in some cases has seen athletes reduce their risk of hamstring strains by 51% ⁵ .

Many sports are also introducing injury prevention programs, such as the FIFA11+ , into pre-season and in-season training sessions. While many of these are aimed at ACL injury prevention, the sport-specific movement patterns they include might assist in reducing hamstring injury as well.

Grades of Injury

Hamstring injuries are graded as either a Grade 1, 2 or 3.

Grade 1 - there is minimal disruption of muscle fibres. There is discomfort at end range stretch and there is discomfort with some resisted activity, however overall strength remains above 80% of expected.
Grade 2 – there is variable disruption of muscle fibres. There is discomfort reported with normal activities (walking, bending forwards). Strength is reduced below 80% normal capacity and stretch range is reduced. It is important to understand that Grade 2 injuries represent a greater spectrum of injury and physiotherapists will use a sliding scale to illustrate the degree of muscle fibre tearing and associated symptoms.
Grade 3 – there is complete disruption of muscle fibres. These types of tears will often require assessment by an Orthopaedic surgeon and may require surgical repair.

Injury Management

A significant amount of time is lost from competition and training (18 days on average) after a hamstring strain injury which can be devastating for athletes and sport teams. A major problem with hamstring strains is that coaches and athletes must deal with the frustration of persistent symptoms and a high percentage (12–31%) of reinjuries ⁵ .

As with all soft tissue injuries, early assessment and management is key. While use of R.I.C.E is still advocated by many sports trainers and coaches, sports physiotherapists and doctors prefer to apply the acronyms PEACE (days 0-3) and LOVE (day 4 onwards). Read more about these here .

Early intervention should aim at educating the athlete and protecting the injured tissue. The goal is to prevent further injury and promote early tissue recovery. Dependent on the grade of injury, this might include variable amounts of rest, activity avoidance, compression and elevation, and gentle activation. Physiotherapists will often focus soft tissue treatment on areas around the injured site such as the gluteals, opposite hamstrings, quadriceps and calf.

As the acute phase settles, it’s time to give that injured hamstring some LOVE – gradually loading up the muscle, using techniques to improve blood flow to the area, prescribing exercises and monitoring the outcomes. And there is plenty of positive reinforcement and education about the injury.

Return to Sport

Return to sport is largely dictated by the grade of the injury and the success of the rehab program. As a ball-park figure, Grade 1 injuries generally return to sport around 10-14 days, Grade 2’s around 21-28 days (although a high Grade 2 may be 6 weeks) and Grade 3’s up to 3 months. This is just a guide though, as many factors can influence whether the athlete can return at a particular period, including exposure to appropriate training loads and volumes, post-training symptoms, number of previous injuries, type of sport and position in team, and athlete confidence in the muscle.

The Take Home

The only way to manage a hamstring injury successfully is through a comprehensive assessment, treatment and return to sport plan. If you have injured your hamstring, get seen early and give PEACE a chance. This is the time to nut out your program and give you direction and confidence in how to manage the injury. Once the acute phase has passed, lean on your physio for advice and guidance and stick to the plan. It will take time, dedication, and diligence, but that hamstring can recover and a successful return to sport achieved.

If your looking for some more information on the management of hamstring injuries, check out this perspective from the Journal of Orthopaedic Sports and Physical Therapy:

Hamstring Injury: What Is It? What Should I Do About It? When Can I Get Back to My Sport?

Injured your hamstring? Give us a call.

At Movement for Life Physiotherapy, we can assess your hamstring, diagnose the cause, and provide you with a comprehensive treatment plan to help get you back to the things you love doing sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

References:

Askling CM, Malliaropoulos N, Karlsson J. High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis. Br J Sports Med. 2012;46(2):86-87.
Ekstrand J, Hagglund M, Walden M. Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med. 2013;39(6):1226-1232.
Ekstrand J, Hagglund M, Walden M. Injury incidence and injury patterns in
Professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553-558.
Thelen, D, Chumanov, D, and Hoerth, M. Hamstring muscle kinematics during treadmill sprinting. Med Sci Sports Exerc38: 108–114, 2009.
Frekleton G and Pizzari T (2013). Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis. British Journal of Sports Medicine, 47, 351–358.

The Hip Joint - Hip Pain & Osteoarthritis

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 01 Mar 2022 05:41:10 GMT

Reduce the chance of hip OA by managing your risk factors and exercising regularly

Osteoarthritis (OA) is the most common form of chronic arthritis and as a disease is currently estimated to affect 2.2 million Australians or 9.3% of the population. While OA can affect any joint, the larger, weight-bearing joints are more commonly affected, namely the knee and the hip. There is no cure for osteoarthritis however many of the risk factors for developing OA are modifiable. The judicious use of physiotherapy services to identify risk factors, develop treatment plans and manage a progressive therapeutic exercise program can significantly assist with managing the symptoms and functional implications of OA.

Anatomy 101

Understanding the impact of hip OA starts with education, and no better place to start than with a little anatomy lesson. Click her e to open an image of the hip joint and learn some basic relevant anatomy of the hip joint.

5 facts about OA from the Australian Physiotherapy Association

What's the risk?

There are a few factors that can contribute to your risk of having hip OA over your lifetime. Some of these are modifiable (ie. they can be changed) while others we are stuck with! Non-modifiable risk factors include family history and age (over 55 years old). Modifiable risk factors include previous lower limb joint injuries, physically demanding careers and being overweight. Through injury prevention programs, workplace risk mitigation and regular exercise these factors can be reduced.

As our population gets older the number of Australians with OA is expected to rise from 2.2 million in 2015 to almost 3.1 million by 2030 (RACPG, 2018). Unfortunately, there is no specific cure for OA and most people will never require surgery, however suffering from hip OA can be very painful and significantly impact your quality of life.

How does it develop?

Throughout everyone’s lifetime, the cells that make up the surface of joints go through a normal cycle of wear and repair. If there is inadequate time for the repair process to occur, then over time, issues can develop. In hip OA there is an imbalance of cartilage cells breaking down and an ineffective repair process resulting in joint degerative changes.

When this occurs the cartilage covering the joint surface gets thinner and, over time, develops fissures or cracks. This irritates the joint, which results in an increase in inflammation, irritation of nerve endings, pain and biomechanical changes.

OA is typically characterised by stiffness, joint pain and swelling. While an xray is not necessary to diagnose hip OA, it may demonstrate some of the effects of hip degeneration, with loss of joint height and development of bony outcrops around the joint. In severe cases imaging will assist in making an informed decision regarding surgical intervention.

How will OA affect me?

Living with hip OA can significantly impact the ability to participate in daily activities and do the things we love. The onset of pain in hip osteoarthritis normally comes on gradually over a period of months to years. Symptoms vary depending on what you do on a particular day. Pain is usually felt in the groin, thigh and buttock region. Walking, standing up or bending down can become increasingly difficult. A common complaint is the difficulty experienced when trying to put on shoes or socks. Overtime, without appropriate care and advice, the muscles around the hip can become weak, which puts further strain on the joint.

How can physiotherapy help me with my hip OA?

The best course of action is to engage early with a physiotherapist who provides targeted treatment, tailored exercises, and education. Physiotherapists are equipped with extensive knowledge of anatomy and disease processes and are well suited to prescribe therapeutic exercises to help increase the strength of the muscles around the hip and improve cartilage health.

Targeted treatment can assist in loosening tight muscles, improving joint mobility and reducing pain. Individualised progressive exercise programs have been shown to help relieve pain and improve function in those with hip OA regardless of age and degree of disease.

Education is really important. Terms like “wear and tear” and “bone-on-bone” are unhelpful and reinforce common misconceptions. This can lead to fear-avoidance behaviours and reinforce a decline in physical activity. It is important to remember that even if your x-rays show limited space between your joints, your symptoms can improve, and you can benefit from exercise. Joints need to be exposed to loads and movement in order to stay healthy, and appropriate exercise is unlikely to worsen your OA even if it causes some pain! In many studies exercise has been shown to relieve pain and improve function in individuals living with hip OA.

What are the possible exercise options for hip OA?

At Movement For Life Physiotherapy we follow evidence based guidelines on exercise prescription for the management of hip OA. Our physiotherapists will guide you through a tailor-made treatment and exercise program which may consist of:

Hydrotherapy
Group Lower Limb Rehab
Core Plus
1:1 Clinic Sessions
Gym or Home Exercise Programs

The Take Home

Hip OA is common and will become more prevalent as our population ages. If you are symptom-free but have risk factors (such as a family history or previous hip injury), get in early and work on a preventative program with your physio. If you already have signs and symptoms of hip joint OA, remember that it can be well managed through joint mobilisation, soft tissue techniques, stretches and exercise. Maintaining activity through appropriately prescribed strength and conditioning exercises is a key to healthy hips.

If your looking for some more information on total hip replacement, check out this perspective from the Journal of Orthopaedic Sports and Physical Therapy:

Total Hip Replacement - How Long Does It Take to Recover?

Do you have hip pain or think you might have hip OA? Have you had hip replacement surgery?

Give us a call. We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons and can treat and manage your hip pain with a personalised, goal-oriented and comprehensive management plan.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Ref: The Royal Australian College of General Practitioners. Guideline for the management of knee and hip osteoarthritis. 2nd edn. East Melbourne, Vic: RACGP, 2018.

Wrist - Distal Radial Fracture

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 24 Feb 2022 11:50:01 GMT

A common injury that needs a considered approach

Distal radial fractures are one of the most common fractures of the body, accounting for approximately 25% of all fractures in children and 20% of all fractures in the elderly. Like many common injuries, rehabilitation of distal radial fractures is often overlooked or downplayed, with many practitioners taking the simplistic view of “it’ll get better with use”. The reality is that wrist fractures can be simple or complex, injured in isolation or with concomitant injuries and, in rare instances, be associated with prolonged symptoms, functional limitations and the development of complex regional pain syndrome. Much better idea to manage that injury with a plan!

What is a distal radius fracture?

There are two bones in forearm spanning the area from the elbow to the wrist - The radius is located on the thumb side and the ulna on the little finger side. The distal radius is the part of the radius that connects to the wrist joint. Check out this little diagram courtesy of Netter's Atlas of Anatomy . When the radius is broken near the wrist, it is known as a distal radius fracture. In kids, it is often referred to as a greenstick fracture, as growing bones are more plastic and flexible. The older we get, the harder our bones become, and the results a little more challenging to manage.

Oh, FOOSH!

A break in the distal radius commonly involves f alling o n an o ut s tretched h and (yep, a FOOSH). A trip, a slip, a loss of balance, and the hand is thrown out to break the fall. Unfortunately, it's not always the only thing it breaks. They can also result from high impact trauma such as a motor vehicle, bike or a skiing accident.

Depending on the direction the radius breaks, it is referred to as either a Colles or a Smith’s fracture, named after the clever people who first classified them. A Colles fracture normally results from direct impact to the palm of the hand. This is a classic FOOSH, such as occurs when you use your hands to break a fall. In this instance, the broken end of the radius shifts dorsally, or toward the back of the hand. They are also called a dinner fork or bayonet fracture due to their appearance on x-ray. A Smith’s fracture is less common. They generally result from an impact to the back of the wrist. The end of radius typically shifts volarly, or toward the palm of the hand. Click here to see an example of a Smith’s fracture.

Is it busted?

Not all distal radial fractures are obvious initially. Kids in particular can have greenstick fractures where movement and function remain OK. The mechanism of injury is usually a good indicator that the wrist might be fractured. Other symptoms to look out for are:

Immediate pain in the wrist
Bruising and swelling
Deformity
Difficulty moving the wrist

An x-ray will confirm a fracture, what type it is, and assist in guiding best practice care.

If it ain’t broke, don’t fix it, but if it is…

Multiple factors need to be considered when deciding on how to treat a distal radius fracture, including:

Whether the bones are out of place (displaced fracture)
Whether there are breaks in multiple places (comminuted fracture)
Whether the fracture extends into the wrist joint (intrarticular fracture)
If the bone has broken the skin (compound fracture)
Whether there are concommitant injuries such as an ulna fracture or injury to the median nerve (multi-trauma injury)

In any case, on presentation to emergency the fracture is usually treated with a splint for comfort and pain control. If the fracture is displaced, it is reduced (put back into the correct position) before it is put into a splint.

Nonsurgical Treatment

The majority of distal radius fractures are managed nonsurgically. The fractured limb is placed in a cast or a splint that remains insitu for up to six weeks. X-rays are taken at the 2-3 week mark to ensure the bones are in the correct position and that healing is occurring.

There are some really cool splints these days, like the Donjoy Exos splint, that allow you to get the splint wet, swim, even participate in some sports (I once saw someone snowboarding in a Exos splint). Best to get some expert advice on these though.

During the first six weeks physiotherapy can provide you with exercises for your fingers, elbow and shoulder to ensure range of motion is maintained. Once the cast is removed, physiotherapy can help you regain proper wrist function and strength.

Surgical Treatment

Surgery is used when fractures are unstable and cannot be treated by a cast alone. Broken pieces of bone are put back together and held in place with metal plates and screws. After surgery, a fixed splint or cast is required for the first two weeks and then changed for a removable splint which is normally worn for another four weeks. It is important to start with physiotherapy early in order regain wrist function and strength. Early range of motion is key to achieving the best outcome after surgery.

Rehabilitation and Return to Activity

In the vast majority of cases people return to all their former activities after a distal radius fracture. The severity of the fracture, the timing of treatment and rehabilitation and the body’s response to treatment all contribute to the outcome. In some cases, you can have permanent limitations in function after a distal radius fracture, but this is the exception, not the rule.

Most people will have stiffness in the wrist which generally lessens in the months after the cast or splint is removed. This stiffness continues to improve for up to two years. Light activities such as swimming can usually be started once the cast is removed. Vigorous activities such as football usually can be resumed between 3 and 6 months after fracture.

The Take Home

Distal radial fractures are common, and when managed well generally have great outcomes. Early assessment and management of fractures is critical to ensure good bony alignment is achieved. Give the bone time to heal, but once you’re out of that cast or splint, do a solid stint of physiotherapy to ensure full functional wrist movement and strength is regained.

Have you recently fractured your wrist?

Do you want better wrist function now and in the future?

Give us a call. We love wrists and we love helping people with all sorts of wrist problems get back to doing what they enjoy most.

The Knee - ACL Injuries Part One

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 03 Feb 2022 10:28:29 GMT

What are ACL injuries? How are they managed? Can we prevent them?

They’re big questions, and to ensure we don’t send you to sleep talking endlessly about ACL's, we've broken it down into 3 parts:

(1) ACL Injury

(2) Injury Management, and

(3) Injury Prevention.

Part One

You may well know someone who has injured their Anterior Cruciate Ligament and, if you’re a sports fan, particularly of AFL or netball in Australia, then you have probably seen one happen, live. They are unpredictable (are they?), dramatic (mostly) and dreaded by athletes, coaches and team mates alike due to the time frame required to recover and return to full sport.

30-40 years ago, they were considered an almost career ending injury. Nowadays, ACL injuries are extremely well diagnosed, managed, and successfully returned to elite sport and daily living. Many will still opt for surgical repair, however there is a growing body of evidence to show that in some presentations conservative (non-surgical) management can have excellent outcomes too. More on that in Part Two.

What is the ACL?

The anterior cruciate ligament is a strong, cord-like band of fibrous connective tissue that spans the inner part of the knee joint, running from the tibia to the femur. It is an important stabiliser, resisting rotational movement and anterior gliding of the tibia on the femur. It is composed of two bundles which tighten at different stages throughout knee movement, providing stability across the range. Pretty nifty.

The ACL has an artery that runs through the centre of it, and a really good nerve supply. This is why they swell so rapidly when ruptured and usually hurt like hell!

How is it injured?

The majority of ACL injuries (70%) are non-contact. This means that there is not an external force such as another player or equipment involved. The classic non-contact mechanism of injury (‘MOI’ in Sports Medicine lingo) is when landing from a height or changing direction and there is excessive knee rotation coupled with side force (either abduction or adduction), or from hyperextending the knee. If you’ve got the stomach for it, here are a couple of examples of non-contact ACL injuries: AFL ACL Injury | Netball ACL Injury .

The reality is though, any activity that exposes the knee to rapid pivoting, twisting and deceleration moments can result in an ACL tear. That’s why it is so common with sports like AFL, netball and alpine skiing.

The remaining 30% of injuries are contact injuries, such as when a player falls across their opponent’s knee or during contact in martial arts. These are often more traumatic and result in collateral damage, such as medial and lateral ligament injuries, posterior capsule injuries and tibial plateau fractures (although these can occur with non-contact injuries too).

An ACL rupture is usually (but not always) accompanied by a “pop” and rapid onset of swelling. They are often really painful (due to that awesome nerve supply) and difficult to weight bear on.

Who is at risk?

While we all have the potential to injure our ACL, they are way more common in people aged 16-35 and in females.

Physio’s often refer to neuromuscular and biomechanical factors for ACL injury risk – big words for how strong we are, how quick muscles react, and our coordination and control of movement. With hindsight, we are often able to identify many of these risk factors. Too little too late perhaps? But it also means, given the chance, we can potentially modify some or all of these factors through targeted exercise programs, training, and controlled exposure to the activity, ie. gradually doing more at higher and more demanding levels. More about that in Part Three.

We can also control some of the external risk factors – things like footwear, the surface we are playing on, the equipment we are using or the weather we are exposed to.

One thing we can’t control is gender. Females are 3 times more prone to ACL injuries than their male counterparts. There are a range of reasons for this, including anatomical features, hormonal changes, body shape and strength variances.

Have I “done my knee”?

The ACL can by strained, partially torn, or completely ruptured. They can be injured in isolation or, more commonly, in conjunction with other structures such as the meniscus or the medial collateral ligament. Some will need urgent medical attention, most require medical imaging and many will still opt for surgery.

What EVERY ACL injury does require though is careful assessment, diagnosis, injury management and prudent rehabilitation.

In Part Two of our three part ACL series, we will take you through a careful and considered approach to assessing ACL injuries, the tools used to diagnose an ACL injury, your treatment options and the rehabilitation pathways we use to get people back to sport and life. And if you want to know how to reduce your risk of ACL injury, stay tuned for Part Three in this series.

If your looking for some more information on the management of ACL injuries, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

If you have knee pain or think you might have injured your ACL, give us a call. We love knees and we love helping people with all sorts of knee problems get back to doing what they enjoy most.

Do you have knee pain?

Have you recently injured your ACL?

Do you want better knee health now and into the future?

Give us a call. We love knees and we love helping people with all sorts of knee problems get back to doing what they enjoy most.

Resources: For a full list of the resources used in this series, contact us via our Contact page.

The Knee - ACL Injuries Part Two

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 27 Jan 2022 01:03:09 GMT

What are ACL injuries, how are they managed, and can we prevent them?

They’re big questions, and to ensure we don’t send you to sleep talking endlessly about ACL’s, we’ve broken it down into 3 parts:

(1) ACL Injury

(2) Injury Management, and

(3) Injury Prevention.

Part Two – Injury Management

Before jumping head-first into management of an ACL injury, it’s worth talking about the different grades of injury and how this might influence your decisions.

Grades of Injury

Contrary to popular belief, not all ACL injuries are complete tears. As we introduced in Part One, the ACL can by strained, partially torn, or completely ruptured. These are referred to as Grade 1, Grade 2 and Grade 3 tears respectively, and this will certainly influence how an ACL injury is managed.

With a Grade 1 tear , thank your lucky stars, because while the fibres of the ligament are stretched, they are not torn. While these injuries may be accompanied by some swelling and tenderness, structurally they are stable and don’t give way with activity.

With a Grade 2 tear , there is more damage. Some, but not all, fibres of the ligament are torn and there is a greater degree of swelling and tenderness due to tearing of blood vessels. There may be some loss of range of movement, and the knee may feel unstable at times.

With a Grade 3 tear , the ligament is completely ruptured and there are often associated injuries. There is often large and rapid swelling, usually within 2 hours, with associated loss of joint range of movement. People often report the knee giving way, sometimes with normal movement, but more frequently with rotational movements. Surprisingly, once the shock has passed, the pain reported is much less than one would expect given the type of injury.

Injury Assessment

As with any knee injury, early, thorough assessment is important. Even if the injury is small, assessment is essential. A good physiotherapist will quiz you about your injury a lot. An excellent physiotherapist will enquire about what you love doing and what your goals are.

Most of the time, the history of the injury will tell us if you have injured your ACL. It can also guide us to other structures that may have been collateral damage. From there, a structured physical assessment confirms our clinical reasoning. This will involve looking at your range of motion, ability to weight bear on the injured leg, muscle strength and activation, and degree of swelling. We also use some special tests to check the integrity of the ACL, as well as various other structures of the knee.

In most instances, medical imaging is indicated. MRI is the gold standard for assessing the integrity of the ACL and can assist in determining the grade of tear (see above), but plain x-rays are also important, as in some instances fractures occur which may require a different management plan.

ACL Injury Management

If the first thing your doctor or physio says about management for an ACL injury is “We need to get you in to see a surgeon”, get a second opinion!

The findings of any assessment, together with the results of any medical imaging and all your treatment options, should be presented to you, the patient, in a clear and concise manner to allow you to make an informed decision.

While surgery for complete ruptures, particularly in younger, athletic populations, is still the most common approach, there is a growing body of evidence for non-surgical management, particularly if the rupture is incomplete or where there is no history of mechanical instability, even in the presence of a complete rupture. When pain, function, return to sport, quality of life and future knee osteoarthritis are considered, the results are strikingly similar regardless of whether a surgical or conservative (non-surgical) approach is taken. So listen to your physio, take some time and make the best decision for YOU .

Rehabilitation is essential. For a Grade 1 tear, this might only be 3-6 weeks depending on symptoms and any pre-existing “risk factors” that might need correcting. The greater the injury, the longer the rehabilitation period, with surgical repairs requiring 9-12 months of rehabilitation before returning to full contact sport.

Rehab is so much more than flexibility and strength. Remember those two terms neuromuscular and biomechanics ? That’s what physio’s are brilliant at. Tapping into methods to get your knee (or any body part actually) moving the way it should - strengthening key muscle groups, stretching tight structures, addressing modifiable risk factors (see Part Three for more on this), exercise prescription, graded return to functional activity and sports related activities and education, education, education .

The Take Home

If you’ve injured your knee, even if it is only a little tweek, you won’t know if you’ve strained your ACL unless you get it assessed. A Grade 1 ACL strain significantly increases your risk of a significant ACL injury in the future, so heed the warning, get it assessed, and do some rehab – it could save you a lot of time, money and missed sport in the future.

And know your options. Health care is about informed decision making. Surgery for an ACL injury should not be a given. Get all the facts, take some time to consider your situation, and don’t feel pressured.

Finally, if you want to know how to reduce your risk of ACL injury, stay tuned for Part Three in this series where we delve into all the details about modifiable risk factors and ACL Injury Prevention programs.

If your looking for some more information on the management of ACL injuries, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you have knee pain?

Have you recently injured your ACL?

Do you want better knee health now and into the future?

Give us a call or click on BOOK AN APPOINTMENT to book online.

We love knees and we love helping people with all sorts of knee problems get back to doing what they enjoy most.

Resources: For a full list of the resources used in this series, contact us via our Contact page.

COVID19 - Returning to Physical Activity & Sport after COVID19 infection

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 26 Jan 2022 23:13:08 GMT

After infection with COVID19, how soon can you return to physical activity and sport?

How you effectively and safely re-engage and integrate with community sport and physical activity post COVID19 infection could be harder than you think.

As the Omicron variant of COVID19 spreads across the Top End community, the chance of every one of us coming directly into contact with COVID19 and testing positive to infection increases. The Top End has an active, vibrant, multi-cultural population. We love the outdoors and sport plays a big part in the lives of many locals. From fishing, to hiking, footy to hockey, golf to basketball.

So how will you know you are right to return to physical activity and sport after COVID19 infection?

Assessing return to Physical Activity

Assessing your physical health and functional capacity is the key to ensuring a safe return to sport. The relative risk of the person returning to physical activity needs to be determined, particularly with respect to cardiovascular, respiratory, and chronic fatigue complications. And then there are any underlying pre-existing medical conditions, the type and level of sport (recreational versus elite) and the training environment to consider. With this information, clinicians can stratify patients into three categories:

Low risk
Intermediate risk
High risk

Generally speaking, low risk patients tend to be younger and have had either no symptoms or very mild respiratory symptoms only. Those patients who have had symptoms for longer periods and accompanying shortness of breath or chest pain, but not hospitalisation, are considered intermediate risk. Elite and endurance athletes are in this group, simply because the demand on their cardiovascular systems is greater ^1,2,3 . Patients who have required hospitalisation, have had prolonged shortness of breath or chest pain, and multi-organ involvement are considered high risk.

While your physiotherapist can assist with assessing this, including getting a detailed history of your experience with COVID19 and collecting relevant physical data, for those people who have had more serious symptoms or required hospitalisation, a multi-disciplinary team approach is indicated, including a GP, Sports Physician, Pulmonary Specialist and/or a Cardiologist.

Graduated Return to Play (GRTP) Protocol

Graded Return to Play (GRTP) protocols are progressive programmes designed to reintroduce patients to physical activity and/or sport in a stepwise fashion. Physiotherapists excel in this area. Various authors ^(2,3,4,5) have produced excellent infographics and pathways to describe GRTP protocols post COVID-19, which can be adapted to reflect the changing severity of disease with different COVID19 variants (Delta, Omicron). We've linked to one below, but the following key points come across from the research:

Don’t go it alone. Get expert advice from a health professional and be guided by their knowledge of GRTP protocols and the variable impacts of COVID19, both physically and mentally. GRTP should be made on a case-by-case basis, with due consideration given to the individual experience of COVID19 infection, pre-existing conditions, type and level of sport, and training/play environment.
Rest Up. If you have had a positive diagnosis of COVID19, you should have a MINIMUM of 10 days rest from the onset of symptoms, be symptom free for 7 days BEFORE commencing a GRTP protocol, and no longer be taking any medications such as paracetamol.
If it aint right, STOP. If, while undertaking the GRTP protocol you experience shortness of breath or chest pain, stop what you are doing and seek medical advice immediately.
Be Patient. Timeframes will vary depending on your pre-COVID fitness levels. Ensure each stage of the GRTP protocol is completed comfortably before progressing to the next stage.
Watch out for the Blues. Don’t forget your mental health. Take some time out to relax and recover, talk through the challenges, and make sure your goals are simple and achievable.

IMPORTANT NOTE: Graded Return to Play protocols are complex, and should be interpreted and implemented by a qualified health professional. The following link serves as an example of what you should be following if you have had COVID19, but please, leave it to the experts to implement a plan for you. Check out a GRTP protocol here .

The Take Home

The implications of COVID19 from a physical activity and sports participation perspective are significant and complex. The simple fact that the pandemic has restricted access and exposure to organised community sport has resulted in large scale community-wide physical deconditioning ^(1,4,5,6) . The additional impacts of COVID19 infection can have serious health implications, impacting the individual’s future sports participation, physical and mental health . Physical assessment and a graded return to play are important considerations post COVID19 to ensure a safe, successful, and sustainable return to physical activity ^(1,3,5,6) .

With extensive industry and sports experience in Graded Return to Play protocols, Movement for Life Physiotherapy are here to help you recover post COVID19 and get back to doing what you love. Give us a call today on 08 8945 3799 or book an appointment online.

References.

Halle et al (2021). Exercise and sports after COVID-19—Guidance from a clinical perspective. Translational Sports Medicine, 4:310–318
Elliott et al (2020). Infographic. Graduated return to play guidance following COVID-19 infection. British Journal of Sports Medicine, 54(19), 1174-1175.
Löllgen et al (2021). Infographic. Clinical recommendations for return to play during the COVID-19 pandemic. British Journal of Sports Medicine, 55(6), 344-345.
Salman et al (2021). Returning to physical activity after covid-19. British Medical Journal, 372:m4721
Jewson et al (2020). Life after COVID-19 - The importance of a safe return to physical activity. Australian Journal of General Practice, 49(Suppl40).
Elliott et al (2021). Understanding the impact of COVID-19 on youth sport in Australia and consequences for future participation and retention. BMC Public Health, 21:448

Athlete Screening

nick.jones@mflphysio.com.au (Nick Jones) — Fri, 21 Jan 2022 06:37:52 GMT

A well designed sport screening will get you ahead of the competition

In the world of sport, and we’re talking all sports, not just elite sport, physiotherapists play a crucial role in injury prevention and performance enhancement. And it all starts with a targeted screening, to assist in identifying any potential risk factors, weaknesses or restrictions that may impact your training and performance.

Now many readers will be reading this and thinking this is just a ploy to get you to come in for further treatment sessions. And while some physiotherapy intervention might be recommended, from our experience, about 90% of the time most issues identified in a screening can be self-managed with a targeted exercise program (and we give you access to this for 8 weeks, for nothing!).

When to get screened

Ideally, screenings are done at the start of pre-season training. This allows plenty of time to develop strength and flexibility without risking an overuse injury. The faster muscles, tendons and joints are exposed to load, the greater the risk of developing an injury that will impact your season. Through an individualised exercise program, strength, flexibility, agility, and endurance can be developed in a sustainable fashion, allowing greater focus on skill acquisition to help you get ahead of the competition.

What’s Involved?

Firstly, we need to know about your past injury history and level of sport that you play, so the first part of the process is designed to talk about these in detail. This information is important as it may guide us to pay more attention to certain areas during a screening and help us pitch exercises at the right level.

Our screenings are sport specific, so assessments vary depending on your chosen sport. We are currently the physiotherapists for the AFLNT Thunder Academy squads and Hockey NT and have screened hundreds, if not thousands, of sports people of all ages over the past 20 years. While we use specific screening tools, we improvise and adjust our screenings to suit the athlete at hand.

In most cases a sport screening will assess joint ranges of motion that are key to your sport, such as hip, knee and ankle for running sports, and thoracic and shoulder for swimming. Biomechanical techniques such as squatting, jumping, and lunging are commonly assessed, as are the strength of different muscle groups and overall flexibility. Some of these assessments might prompt us to undertake specific tests, but we will discuss these with you during the session.

What happens following the screening?

The Physiotherapist will discuss with you any identified impairments, weaknesses, or issues you may have and the best way to manage these to achieve your goals. We use Physitrack to provide you with a specific exercise program. With 8 weeks access, we can use the app to communicate with you and ensure exercises are specific, effective, and providing you the best chance of performing well and remaining injury free throughout the season.

At Movement for Life Physiotherapy, our clinical staff are experienced in screening for a wide range of sports.

Start off your pre-season on the right foot by booking in a screening today.

Call now on 08 8945 3799 or book online.

The Knee - ACL Injuries Part Three

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 20 Jan 2022 02:00:39 GMT

What are ACL injuries, how are they managed, and can we prevent them?

They’re big questions, and to ensure we don’t send you to sleep talking endlessly about Anterior Cruciate Ligaments (ACLs), we’ve broken it down into 3 parts:

(1) ACL Injury

(2) Injury Management, and

(3) Injury Prevention.

Part Three – Injury Prevention

ACL injury rates are on the rise, particularly in younger populations and in females. In Australia, part of this rise is attributable to the rapid increase in uptake of dynamic sports such as AFL, Rugby and soccer by females, but it is also influenced by many other factors as discussed in Part One. In this blog, we are going to look at those risk factors that are modifiable, programs that claim to help reduce the risk of ACL injuries, and what the evidence so far says about these programs (spoiler alert, it’s pretty good).

Risk Factors – Modifiables

As discussed in Part One, there are a lot of risk factors for ACL injury that we CANNOT change – things like gender and anatomy. When considering injury prevention programs, it is the MODIFIABLE risk factors that we are interested in.

We’ve used the term neuromuscular a few times in this blog series, medical lingo for the system that facilitates and controls movement in our muscles and skeletal system. And the cool thing about this system is it is ADAPTIVE . We can change it. It is MODIFIABLE .

With ACL injury prevention, the neuromuscular factors we are talking about can be broken down into four categories:

Movement and alignment – how does the knee move? Are there any restrictions above and below the knee joint (for example, a stiff ankle joint will increase load on the knee joint)? How well do the gluteal (hip) muscles control the dynamic position of the knee?
Strength – Good quadriceps, hamstring, gluteal and trunk strength is essential for good knee control. A weak quadricep muscle will reduce knee flexion, while weak hamstrings, hip abductors and core muscles can all impact on dynamic knee position resulting in an increase in knee valgus position.
Ground Reaction Forces (GRFs) – this refers to the amount of force the ground applies back onto the body. If muscle strength is reduced, the load applied back through to other structures such as joints and ligaments can be increased. We need strong muscles to be able to absorb and counter high GRFs.
Fatigue – as we fatigue, we gradually lose motor control, which exacerbates the risk factors noted above – reduced strength, alterations in movement patterns and reaction speeds, and increased transference of load to joints and ligaments.

Now this might sound complicated, but a well-designed exercise program coupled with targeted physiotherapy intervention can help get all of this under control.

ACL Injury Prevention Programs

Imagine if we could prevent ACL injury . In doing so, we would bypass the physical trauma of the injury, reduce surgery costs and associated risks, reduce interruptions to a sports season, and minimise time lost to essential treatment processes.

While the term prevention is used a lot, risk reduction is probably more appropriate. Over the past 10 years, there has been an explosion in the number of programs aiming to reduce ACL injury risk. Many sporting associations have designed their own programs, incorporating activities and movement patterns specific to their sport. Examples include the FIFA11+ program for soccer, Netball Australia’s KNEE program , the Prevent Injury and Enhance Performance (PEP) Program , and the recently released AFLW Prep-to-Play program.

What all these programs have in common is the inclusion of multiple physical components to address neuromuscular deficiencies including flexibility, strength, plyometrics, balance and agility, and running. This combination of activity reduces all knee injury risk, including ACL, when participated in on a regular basis.

Do they work?

Yes, they do. The FIFA 11+ program is reported to reduce the incidence of ACL injury by about 30%, while various systematic reviews (Noyes and Barber Westin, 2021 and 2014, Dargo et al., 2017) demonstrated a reduction of ACL injury rates with the PEP Program. Arundale, Bizzini, Giordano et al. (2018) published clinical practice guidelines for ACL injury prevention and summarised that “ there is robust evidence for the advantages of exercise-based knee injury prevention programs, including reduction in risk for all knee injuries and for ACL injuries specifically, with little risk of adverse events and minimal cost ”.

Moreover, these programs can be targeted and implemented safely and effectively by coaches, parents, health professionals and sports trainers.

Keep in mind these programs are not a panacea though, and good clinical assessment, treatment and targeted intervention is imperative in overall ACL injury risk reduction.

The Take Home

If you’ve injured your ACL, participating in an ACL injury prevention program is essential, for life (or at least as long as able!). It should basically become part of your weekly routine, like washing your hair or putting the bins out. It does not need to be arduous or excessively time consuming. Most of the warm-up programs listed above are designed to be completed in 20 minutes, 3-4 times per week, and are adjustable to fit with your changing physical capacity and ability.

Keep in contact with your physiotherapist. They are the key medical professional in your knee health now and into the future. A simple check-up to monitor your knee strength, range of motion and functional control against baseline measures and adjust your exercise program will help keep you active for longer and your knees happier and healthier.

If your looking for some more information on the management of ACL injuries, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you have knee pain?

Have you recently injured your ACL?

Do you want better knee health now and into the future?

Give us a call or click on BOOK AN APPOINTMENT to book online.

We love knees and we love helping people with all sorts of knee problems get back to doing what they enjoy most.

Resources: For a full list of the resources used in this series, contact us via our Contact Us page.

NDIS - Managing persistent pain successfully

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 14 Dec 2021 03:16:01 GMT

Why exercising smarter, not harder, is the key to managing persistent pain

The NDIS can be overwhelming. With so many providers offering so many services, where do you start?

We’re unpacking this for you, using a treatment focus approach that highlights some of the benefits of different

types of services that physiotherapists provide to people on the NDIS.

Persistent Pain

Persistent pain conditions are responsible for the 2nd largest burden of disability in Australia. Approximately 3.37 million Australians live with persistent pain that impacts every facet of their lives. 1.45 million also live with depression and anxiety. Of these individuals, 10 percent will have severe disability and dysfunction due to their chronic pain conditions.

Persistent pain is complex and presents in a variety of ways. While it can be present in isolation it is more commonly secondary to another disease process, injury or disability, such as arthritis, diabetes or fibromyalgia.

Exercise for pain relief

Most people when they have pain reach for medications – Paracetamol and anti-inflammatories. We’ve been indoctrinated to go to these as solutions for pain, largely ignoring the benefit of movement, exercise and graded loading. Pain-relieving medications can play a role in helping to manage pain, particularly in the short term. For longer term improvements though, we must incorporate movement, exercise and strengthening, to improve joint health, muscle strength, and function.

Motion is Lotion

In the physio world, we have a saying: “ Motion is lotion ”. The body loves to move, craves it, and depends on it for normal physiological function. When we move, we increase blood flow to the working structures, bringing all sorts of goodies to the area to help oxygenate, lubricate and nourish. When movement is restricted, perhaps due to disease progression, trauma or surgery, our body adapts. Muscles get a little shorter and weaker, tendons get stiff, and our nerves become sensitised. All of this can result in persistent musculoskeletal pain.

Now pain doesn’t necessarily mean that a structure is being damaged. Sometimes we experience pain because a structure, say a muscle, is just stiff and being moved beyond its CURRENT happy limit. That’s OK. If that muscle is gradually exposed to tolerable amounts of load, over time it will ADAPT to the new load, often improving its functionality and reducing pain.

How to exercise and not “flare-up”

It’s possibly the biggest fear for someone with persistent pain – the fear of being laid up for days on end with pain following an exercise session.

When we’re talking about exercise in the context of persistent pain, we need a little more clarification. It’s not all about bicep curls, burpees and squats. Quite often it’s just gentle movements across gravity, stretches to the onset of tightness or nerve glides lying on your side. A new program might take 5 minutes a day to complete, while others might be longer.

Exercises might be done in a pool or on land, indoors or outdoors. They might be done as part of a group or on your own. A lot of this is determined by YOUR preferences, and what works best for YOU . All of this is super important. If you don’t like doing it, it makes you sore, and isn’t helping you to achieve your goals, then you are not going to persist with it. We know that if the person is engaged and empowered, the results (and therefore your happiness!) will be far superior.

Getting the load just right – the rule of 10

A little bit of exercise goes a long way, but it can be in the wrong direction if the type and volume prescribed is incorrect. Successful pain reduction with exercise dictates that the LOAD (ie. how much resistance or weight) and the VOLUME (how much you actually do) is spot on.

The rule of 10 relies on the intensity of the effort versus the reported pain level is one method of achieving this. This method uses simple visual analogue scales to help the client determine the level of exercise intensity they should be performing AT THAT TIME .

Let’s say you have a pain level of 6/10 while performing an exercise. We would then suggest that your perceived INTENSITY level be at a level of 4/10. If tomorrow your pain is a little better, say a 3/10, push a little harder to a 7/10 intensity. Of course, this is just one method for guiding exercise. Physiotherapists use a variety of techniques to achieve the right load - hydrotherapy programs, pilates exercises, land-based programs and functional programs.

Do you want to get more out of your NDIS funding?

Then give us a call.

All our clients are individually assessed and programs tailored to your specific goals. We are the only QIP Accredited Physiotherapy services in the Northern Territory and an approved NDIS provider. We offer a broad range of services to assist with management of persistent pain, including hydrotherapy, manual therapy, massage, graded exercise programs, clinical pilates and functional rehabilitation, all delivered by a highly skilled team.

NDIS - Why hydrotherapy can be the perfect addition to your plan

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 07 Dec 2021 00:25:45 GMT

Exercise, relax and play - all in one hydrotherapy session

The NDIS can be overwhelming. With so many providers offering so many services, where do you start? We’re unpacking this for you, using a treatment focus approach that highlights some of the benefits of different types of services that physiotherapists provide to people on the NDIS.

Hydrotherapy

Hydrotherapy is a form of physical therapy that utilises heat, buoyancy, and water to treat and manage a variety of conditions. In the NDIS setting, this might include cerebral palsy, autism, ADHD, growth disorders, amputees, and genetic disorders.

Using the physical properties of water, sessions are tailored to be patient-centred and goal oriented and can improve your strength, flexibility, joint health, balance, reflexes, and mood. Sounds like a good place to start!

Graded Loading

One huge advantage of hydrotherapy for people on the NDIS is the ability to modify the amount of load going through a joint. From floating on top of the water, to standing in shoulder depth water, the load going through a body part can be anywhere from 10% to 90% of bodyweight. As an example, consider an adolescent male with cerebral palsy who has fractured his foot. In the pool, the buoyancy of the water takes a percentage of the body weight – the deeper the water, the greater the load off the foot. Using this simple principal, we can get the person walking again, practicing a normal walking pattern, developing strength in walking muscles, and gradually gaining confidence as the injury continues to heal.

Strength and Conditioning

Water provides excellent resistance to allow the development of strength. The force required to ‘shift’ the water when we move provides resistance that can be manipulated to improve joint range of motion and develop muscle strength. By modifying how fast or what direction we move the body part, or by changing the amount of resistance there is, the exercise can be adapted to meet the goals of the client. Going back to our cerebral palsy client, adding small floats to the ankle while walking will make certain muscle groups work harder and challenge his core stability. Supporting him in a freestyle swim position and getting him to kick will strengthen thigh muscles and aid ankle range of motion.

For more information on Strength and Conditioning programs for NDIS clients, click here .

Balance and Coordination

Have you ever stood in the water at the beach while a wave crashed into your legs? Or tried to stand in water that is moving fast? Turbulent water can really challenge our balance. In the hydrotherapy setting, skilled physiotherapists can produce a variety of turbulence to challenge balance. In the case of a fractured ankle where the person may have been non-weightbearing, regaining balance and coordination will be a crucial rehabilitation goal to ensure full recovery and reduce the risk of future injuries.

Relaxation and Pain Relief

In a hydrotherapy pool, the water is maintained at a temperature of between 33 ^o C and 35 ^o C. Not only is it a pleasant environment for NDIS clients to exercise in this temperature aids the release of natural endorphins, allowing tight muscles to relax and in many cases reduce pain. Pool sessions can alternate from exercise to relaxation and back again, reducing stress and anxiety and improving physical and mental health outcomes from hydrotherapy sessions.

Work and Play

When working with kids on the NDIS, there is often no better way to get them engaged and moving than water play. Targeted play can be heaps of fun for the client, young and old, and produce fantastic results. Back to our adolescent boy with a foot fracture. Ball games that encourage him to push off his toes, bounce side to side, change direction and explode out of the water will equate to improved strength (both power and endurance strength), flexibility, balance, agility, and coordination. Managed in short bursts of high intensity or longer stretches of easy play the physiotherapist can control the cumulative load and produce excellent client centred outcomes.

Confidence and Progression

Humans are not fish, so hydrotherapy needs to be able to translate to the land.

And it does.

From improved transfers between chairs, improved walking tolerance, participating in shopping trips, to cooking at home, hydrotherapy can help people on the NDIS achieve their own personal goals and strive for more.

Do you want to get more out of your NDIS funding?

Movement for Life Physiotherapy are the only QIP Accredited Physiotherapy services in the Northern Territory and a registered NDIS provider. We offer a broad range of services in addition to hydrotherapy, including manual therapy, massage, strength and conditioning, clinical pilates and functional rehabilitation, all delivered by a highly skilled team.

NDIS Referral Forms

NDIS - How a strengthening program can help you achieve your goals

Sun, 05 Dec 2021 23:17:43 GMT

What's your goal? Walking? Wheeling? Maybe even surfing!

The NDIS can be overwhelming. With so many providers and so many services, where do you start?

We’re going to unpack this for you, using a treatment focus approach that highlights the benefits of different

services that physiotherapists provide to people with disability.

Strengthening

Strengthening, or Strength and Conditioning (S&C) as it is commonly referred to now, covers a huge area of rehabilitation. While it might drum up images of bulging muscles and weightlifters, strength and conditioning offer’s a plethora of benefits and can be achieved in a wide range of ways. Yes, with a S&C program you are going to get stronger, but you will also improve your flexibility, joint health, balance, reflexes, and mood. Sounds like a good place to start!

S&C programs are one of the key services that physiotherapists provide. In fact, we offer it to EVERYONE . That’s how important it is. Where Physio’s differ from other providers is in our detailed knowledge of human anatomy and physiology AND how disease processes, pathology and disabilities can affect these.

Take muscles for example. They are super adaptable, right throughout our lives. When we use them, they stay healthy, strong, and functional, enabling us to do all the tasks we like to do – walking, sitting, standing, bending, dancing, running, lifting. But if we stop, even for short periods of time, they get weaker, reduce in size, and get tight. They decondition.

Muscle Deconditioning

Muscle deconditioning is an adaptive process – it is the muscles ADAPTING to their NEW ENVIRONMENT , in this case reduced activity. This might be the result of an illness, an operation, or a disease process. The result is reduced load capacity and reduced power generation. Once deconditioned, even doing simple tasks like sitting up in bed or eating a meal can become difficult, even painful, to do. The reduced exposure to activity often results in muscle tightness developing, further reducing activity and ultimately greater muscle deconditioning.

Functionally, deconditioning manifests as reduced capacity to live our daily lives and a loss of independence. These are frequent reasons for clients on the NDIS seeking physiotherapy treatment.

Muscle Conditioning

S&C programs must be tailored to the individual and be adaptable to the changing health needs of the NDIS client.

Take for example, a cancer patient who, during chemotherapy treatment has a fall and requires emergency hip surgery that results in a prolonged hospital inpatient stay. A physiotherapy led strengthening program in this situation would firstly involve understanding the individual’s current limitations and what their goals are. Perhaps they can only walk a few steps, are unable to ascend stairs, or cannot transfer to a toilet. A strength and conditioning program would be goal-oriented to improve these functional capacities through a progressive plan of targeted exercises.

The program might utilise a range of approaches. For example, hydrotherapy can be used initially to expose muscles to low loads and permit the client to walk with the buoyancy of water. This might be complimented with bed exercises, again getting muscles to work with or across gravity, with gradual progressions to more challenging positions.

Load Management

Load management (ie. how much) and exercise progressions (ie. what type) can be monitored against strength outcomes and functional capacity, and carefully balanced against the client’s other health conditions and needs. In time, the goal might be to transition to land-based exercises, then a gym program and dynamic functional strengthening.

Practically, this might allow the client to go shopping for basic groceries items, assist with household activities such as gardening and cooking, be independent moving around the house and feel confident, happy and capable again. For a severely deconditioned person, this process may take many months, but with careful planning and recognition of milestones, it can be a hugely rewarding process.

Why a Physiotherapist?

Physiotherapists have an excellent understanding of these processes and how muscles adapt in the presence of underlying disease. In the allied health field Physiotherapists are well positioned to assess, manage, and prescribe targeted rehabilitation programs to meet individual client needs and functional goals, working collaboratively with other health professionals to deliver patient-centred care.

Do you want to get more out of your NDIS funding?

Then give us a call.

Movement for Life Physiotherapy are the only QIP Accredited Physiotherapy services in the Northern Territory and an approved NDIS provider. We offer a broad range of services including manual therapy, massage, hydrotherapy, strength and conditioning, clinical pilates and functional rehabilitation, all delivered by a highly skilled team.

The Shoulder Joint - Frozen Shoulder

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 24 Nov 2021 03:54:55 GMT

Why some TLC might be the best way to thaw a frozen shoulder

Frozen shoulder, or adhesive capsulitis, is a relatively common condition that effects 3% to 5% of population. Characterised by gradual onset of shoulder pain, stiffness and inflammation, it is often misdiagnosed in the early stages as bursitis or arthritis, resulting in delayed referral to physio and a protracted period of limited shoulder movement and pain.

How does Frozen Shoulder develop?

Pathologically, frozen shoulder develops when inflammation in the capsule of the shoulder progresses to fibrosis of the capsule. Essentially adhesions develop within the layers of the joint capsule, robbing it of its elasticity and flexibility. Why this happens, we’re not sure, but it results in a tight joint capsule that makes the shoulder physically tight, stiff and painful to move.

Frozen shoulder can develop insidiously (ie, with no causative factor identified) or following trauma or surgery. It most commonly affects people between the ages of 40 and 60 and occurs in women more often than men. In addition, people with diabetes are at an increased risk for developing frozen shoulder. Initial symptoms include pain and weakness, with reported difficulty getting dressed, scratching your back and reaching above your head.

Why “Frozen” Shoulder?

The term ‘Frozen’ Shoulder came about because of the course this condition follows when left untreated – Gradual increase in stiffness and pain ( freezing ), a period of very restricted movement ( frozen ), and a period of gradual freeing up ( thawing ). The reality is that left untreated this process can take anywhere from 9 months to 3 years to transpire, with the end result still being a somewhat restricted, functionally limited shoulder. Hmmmm.

How is Frozen Shoulder diagnosed?

A detailed history and thorough assessment of the shoulder by a physiotherapist can usually accurately diagnose frozen shoulder. In some instances, referral for medical imaging (xray or MRI) may be required to differentiate between other potential causes of shoulder pain or co-morbidities such as a rotator cuff tear or arthritis.

Referral to an orthopaedic surgeon is not usually required though in some recalcitrant cases this may be required.

So, what is the best course of action?

Well first, let’s debunk two theories:

1. Don’t “Do nothing” . Essentially this just prolongs your pain and reduces the chance of a full recovery. At the end of the day, movement will return, but there is likely to always be some degree of restriction.

2. Don’t treat aggressively. If you’ve got a painful, restricted shoulder, that you can’t lie on at night, the last thing you want is someone telling you “No pain no gain”. This might get some movement back, but it’s going to hurt like hell and you are not going to be happy.

Which leaves us with a huge area in between! And this is where results lie.

The best treatment will be patient-centred and goal oriented. It varies for every person, and so treatment needs to be tailored to you. We know that there is a lot of muscle spasm and restriction associated with frozen shoulder, so addressing these with soft tissue work, dry needling, gentle stretching and strengthening is paramount. Pain levels should be well controlled and hydrotherapy can be great for helping this and getting some gentle movement going. Also, sleep is super important, so helping you find a regime to keep you comfortable at night is essential. Your GP might prescribe pain relief, while non-pharmaceutical approaches such as hot packs and TENS can provide temporary relief.

Corticosteroid injection may be considered in some instances, but patients are advised that these often do not result in clinically beneficial long term outcomes.

If your looking for some more information on the management of frozen shoulder, check out this perspective from the Journal of Orthopaedic Sports and Physical Therapy:

Frozen Shoulder: What Can a Physiotherapist Do for My Painful and Stiff Shoulder?

What now?

DON’T WAIT! The longer you put up with it, the greater the challenge to get movement back.

At Movement for Life Physiotherapy, we can diagnose the cause of your shoulder pain and let you know whether your shoulder really is frozen or if there is something else going on. Once we know that your shoulder is frozen, our physiotherapists will help you to get that shoulder thawed out so you can get back to business as usual sooner.

Give us a call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

The Knee Joint - Meniscal Tears

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 23 Nov 2021 01:29:02 GMT

Meniscus (men-isk-us); Meniscal (men-isk-l); Menisci (men-isk-eye)

The meniscus is one of those things that when you start talking to patients about them, their eyes glaze over and they start fidgeting with their phones, looking for a simpler explanation to their knee pain.

What are they?

To put it in simple terms, the menisci are the shock distributors of the knee, sitting between the thigh bone (femur) and the lower leg bone (tibia). These C-shaped pieces of cartilage are important for dispersing load - when we walk, run, hop, jump and twist – pretty much everything we do. They help to stabilise the knee during rotational movement with assistance from ligaments and muscles, and improve the area of contact between the bones, which in turn helps the knee move smoothly and in line. There is a medial one, and a lateral one, and, REALLY IMPORTANTLY , they have minimal blood supply. More about this fact later.

Finally, they are super important. Many years ago, a basketball team was losing a lot of player time to meniscal injuries. So, one off season, the team doctor decided to get them removed.

From all the players.

Gulp .

The outcome was a lot of early onset osteoarthritis, and, at a guess, a big lawsuit.

Injury to the meniscus

Injury to the meniscus is relatively common, particularly in twisting sports – think AFL, hockey, soccer, netball, dancing and martial arts. The most common mechanism of injury involves a twisting motion through a planted foot, with a resultant tear of the cartilage. These can be small, large, or even a flap tear (what we like to call 'bucket handle' tears) that can result in the knee ‘locking’.

Acute tears are more common in younger populations and are usually (but not always) associated with pain around the joint line, swelling and difficulty weight bearing. Chronic tears can also occur. These are more more common in the older population as the meniscus naturally becomes worn over time. They are often pain free and go unnoticed, but can also be functionally limiting and debilitating.

What to do

Importantly, if you have injured your knee, get it properly assessed first by a physio. There are lots of structures in the knee that can cause pain, and the meniscus is rarely injured in isolation. We know this stuff really well and have a battery of tests to help determine what is casuing your knee pain.

If you have torn your meniscus, particularly the inner part of the 'C', then it will not repair naturally. Why? Well, remember how it has a poor blood supply? This means that it cannot get enough of the good stuff from the blood to repair. This does not mean they don’t get better. Often, once inflammation has resolved and normal knee movement and strength is regained, people can continue with normal activity and sport pain free. That’s where good physio’s come in, with a graded loading program that is goal-oriented and patient-centred.

Larger tears, bucket handle tears and tears resulting in locking of the knee may require referral to a surgeon, something we can assist you with if needed. And if you are young and your tear is acute, you may be able to get the meniscus surgically repaired which generally has very good outcomes.

If your looking for some more information on the management of Anterior Knee Pain, check out this perspective from the Journal of Orthopaedic Sports and Physical T herapy:

Optimizing Recovery After Knee Meniscal or Cartilage Injury: Guidelines Help Deliver Quality Care

Got knee knee pain and want to know the cause? Give us a call.

At Movement for Life Physiotherapy, we can assess and diagnose the cause of your knee pain and let you know whether you have torn your meniscus, injured a ligament, or sprained the joint. With a clear diagnosis and tailored management plan, we'll help get you back to the things you love sooner.

Give us a call now or click on BOOK AN APPOINTMENT to book online.

The Shoulder Joint - Rotator Cuff Injuries

nick.jones@mflphysio.com.au (Nick Jones) — Sat, 06 Nov 2021 05:22:11 GMT

Some 'barra, a croc, and a rotator cuff injury

True Story:

“How did you hurt your shoulder?” I asked.

“Well, we’d been ‘barra fishing the South Alligator and were heading back to camp, cracking along, up on the plane, when we hit a big saltie on the surface. I went from the back to the front of the boat like that. My right shoulder hit the instrument panel and stopped me dead. Glad it did though. Two others ended up in the drink, and I had no desire to be in there with them!”

Not all rotator cuff injuries are as dramatic as this (and in case you are wondering, the others got out of the river unscathed!). Yes, acute trauma can play a role in injuries to this muscle group, but more often they are a result of years of wear and tear, and an innocuous event, like lifting down the Christmas tree from the top shelf, that results in a rotator cuff tear.

What is the rotator cuff?

The rotator cuff is a group of four small muscles whose role is to both assist with specific shoulder movements and to provide stability to the shoulder joint. They originate from the shoulder blade, cross the shoulder joint and attach to the head of the humerus, forming a “cuff” around the shoulder joint. As a group, the rotator cuff work together to fine-tune movements and provide stability to the shoulder girdle. Individually, they assist with almost every movement that the shoulder joint makes, from lifting a cup of tea, to reaching your back pocket, to reeling in a big ‘barra.

Why is the rotator cuff important?

The shoulder joint is a “ball and socket” joint and has the largest range of movement of any joint in the human body. It achieves this by sacrificing stability for mobility. If you think of the shoulder joint being like a golf ball on a golf tee, the roll of the rotator cuff is to keep the ball on the tee, or, to hold the head of the humerus in the socket. By doing this the rotator cuff stabilises the joint and ensures the head of the humerus remains in the centre of the socket through the full range of movement. Pretty nifty.

What is a rotator cuff injury?

A rotator cuff injury involves damage to the muscle or tendon of any or all, of the four rotator cuff muscles. The injury might be acute, such as from a fall or from direct trauma to the shoulder or be from chronic overuse (“wear and tear”). They are more common in females, and our risk of sustaining a rotator cuff injury increases with age.

Symptoms include pain in the shoulder, neck, and upper back region, altered movement patterns (shrugging of the shoulder when lifting the hand overhead) and restricted range of movement, particularly reaching behind the back or overhead. Acute trauma or large forces can result in significant tears, and some movements may be completely lost.

How can physiotherapy help with my rotator cuff injury?

First , physiotherapists are great at assessing and diagnosing rotator cuff tears. Not all shoulder pain is caused by a rotator cuff tear, and we can help sort this for you. If necessary, we can refer you for an Xray and an MRI, which can assist in confirming a diagnosis, or refer you to your doctor for management by an orthopaedic surgeon if indicated.

Second , we are great at managing rotator cuff injuries. Whether you are being managed conservatively (ie. Not having surgery) or are recovering from a rotator cuff repair, we can help.

Physiotherapists provide education on your injury and pain management strategies to allow the tissues to settle and recovery. When you are able, physiotherapists will assist you to regain movement in the shoulder, and set you a progressive loading program, with a focus on achieving good shoulder blade strength and movement, and then shoulder function. This process is essential in providing the shoulder joint with a sound foundation for movement and for maximising functional movement outcomes.

Ready to sort out your shoulder pain?

If you have shoulder pain, the earlier you get it looked at by a physiotherapist, the better your chances of a successful outcome. Give us a call or click on BOOK AN APPOINTMENT now.

Hydrotherapy for Osteoarthritis

nick.jones@mflphysio.com.au (Nick Jones) — Sat, 06 Nov 2021 03:20:05 GMT

Moving, just keep moving.

Osteoarthritis (OA) is common. It affects approximately 1 in 5 Australians over the age of 45 and 1 in 3 over the age of 75 years old. That equates to over 4 million Aussies and rising. It is the second most common cause of early retirement and costs the Australian health system a whopping $5 Billion dollars annually.

OA is thought to result from the bone working extra hard to repair itself. This might be the result of acute trauma, damage to ligaments, inflammation of the joint, or malalignment of the joint. While the most commonly affected areas include the hips, knees, first toe, and fingers, OA can affect any joint. Symptoms may include:

Stiff and swollen joints
Muscle weakness
Joint pain
Difficulty performing normal daily activities such as climbing stairs or even sometimes just walking can be difficult and painful

The evidence for managing osteoarthritis is unequivocal – EXERCISE.

While some over the counter medications may provide temporary relief, what your joints need is graded exercise. This will help stimulate the joint line cartilage, stretch out joint capsules and ligaments and get muscles stronger to provide a dynamic support to the joint.

Many people with OA find land-based exercise painful and challenging. Fortunately, research shows us that aquatic exercise is equally as effective as land-based exercise in improving quality of life, pain and function for people with knee osteoarthritis. And you don’t need to be able to swim .

There are many benefits associated with exercising in water:

Buoyancy. When we stand in waist deep water, our body weight is reduced by 50%, allowing you to move more freely and with less pain.
Resistance. The water provides a force to move against, helping strengthen muscles and improve function.
Warmth. The heated water in a hydrotherapy pool helps to relieve pain and improve flexibility.
Cardio. Exercise in the pool is a great way to increase your heart rate when this may be too painful to do on land.

Studies have shown that attending twice weekly for a minimum of six weeks has the best outcomes but speak with your physiotherapist as combining hydrotherapy with a land-based program may be better for you. Give us a call now to find out how hydrotherapy can help you.

If your looking for some more information on the benefits of exercise and hydrotherapy for osteoarthritis, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Resources:

Waller B et al. Effect of therapeutic aquatic exercise on symptoms and function associated with lower limb osteoarthritis: systematic review with meta-analysis. Phys Ther. 2014; 94:1383-1395
Barker AL, Talevski J, Morello RT, Brand CA, Rahmann AE, Urquhart DM. Effectiveness of aquatic exercise for musculoskeletal conditions: a meta-analysis. Arch Phys Med Rehabil. 2014 Sep 1;95(9):1776-86

Dizziness and Vertigo

nick.jones@mflphysio.com.au (Nick Jones) — Wed, 27 Oct 2021 02:52:59 GMT

“You spin me right round baby right round…”

As kids, we used to love spinning around in circles, making our worlds spin when we stopped and laughing at each other when we tried to walk.

But when it is not self-induced, it’s not nearly as much fun. If you have ever suffered from dizziness or vertigo, you know how stressful and limiting it can be. And how unwell you can feel. Dizziness describes a range of sensations that include light-headedness, fainting, unsteadiness or loss of balance. The good news? Physio can really help.

Dizziness and vertigo affect approximately 15% to 20% of the adult population every year. That’s a huge amount! And if you live with dizziness, you know that it significantly impacts your quality of life, making it difficult to walk, drive, work, even enjoy spending time with family and friends. Even watching the TV or reading a book can be impossible.

Dizziness can be postural, where on changing from a seated or lying position, you experience a bout of light-headedness and/or dizziness. The cause is often transient – a drop in blood pressure results in a reduction of blood flow to the brain and the body responds by saying “Whoa there, give us a moment to catch up!”

In many instances though, dizziness is a consequence of a problem involving the vestibular system (inner ear). The vestibular apparatus is a complex system of tiny hair follicles and crystals that move based on the position of our head. Think of it like sea grass, wafting back and forth with the movement of the water. When the crystals move the hair follicles, a signal is sent to our brain registering the position, helping co-ordinate eye and head movements and maintain balance.

Vertigo is one type of dizziness that it is caused by the crystals in the vestibular apparatus being out of position. Often described as a ‘spinning’ sensation and is usually brought on by a sudden change in position. Some people report it feels like the room they are in is spinning or as if you are going to fall. These symptoms may lead to other problems, such as loss of confidence, falls, headaches, anxiety and depression.

Other common presentations arising from the vestibular apparatus include benign paroxysmal positional vertigo (BPPV) and vestibular migraine, both of which are largely underdiagnosed. Other causes of dizziness include inflammation of the inner ear (called vestibular neuritis), Meniere’s Disease, acoustic neuroma, otoxicity and stroke.

Fortunately, dizziness and vertigo can be effectively assessed and treated by a physiotherapist. If you have vertigo or BPPV, effective treatment can often have immediate relief. Using specific combinations of movements and manoeuvres, a physiotherapist can help the crystal particles in the inner ear to reposition. Coupled with exercise-based vestibular rehabilitation, vertigo and dizziness can be effectively managed, significantly improving your balance and reducing the risk of injury from falls.

Need a Physiotherapist?

Movement For Life Physiotherapist have a number of physiotherapists with post graduate training in the management of dizziness and vertigo. You can learn more about them here . Our physiotherapists can accurately assess and treat you, or if required, refer you to see a medical practitioner for further investigation or assessment. To make an appointment, call us on 08 8945 3799 or book online.

Exercising while Pregnant

Tue, 17 Aug 2021 03:14:08 GMT

Why you and your baby might benefit from exercise.

We’ve come a long way, baby!

As physical health professionals, we’ve known for a long time that exercise during pregnancy is good for you. But what about the baby? Recent studies are dispelling the myth that exercise negatively impacts the growing foetus and are demonstrating that exercise is good for both Mum and bub.

While our knowledge in this area is still evolving, we now know that exercise during pregnancy:

Reduces the rate of premature births.
Has no associated risk with reduced baby size for gestational age or with low birth weight.
Has no associated risk with miscarriage or still birth.
Reduces the risk of developing gestational diabetes and hypertension by more than 35%.
Improves your mental health

This is great news for pregnant women wanting to keep active during a pregnancy.

Let’s go for a run then!

Steady on. We know that exercise IN GENERAL is good for you during a pregnancy, but there are some important factors to consider. This is where your Physiotherapist can get involved.

As highly skilled clinicians, Physiotherapists provide a critical role in educating and prescribing appropriate exercise advice to women throughout pregnancy. Physio’s know to screen you for problems and precautions related to exercise, and can liaise with other health professionals such as your Midwife or Obstetrician to ensure exercise is safe for you.

Treat the person, not the condition

That’s right, we want to treat you, the individual, not your pregnancy.

Every person will be different, with a different past history and future goals. Likewise the exercises you undertake, the volume you do, how frequently you do them and the environment in which you undertake that exercise will be different. Your physiotherapist will use this information to develop a program based on the types of activities you might best engage with. Sometimes the best options are things you’ve never even thought of!

What’s it going to take?

Not a lot really. Just 21.5 mins per day to be exact! Women should be aiming for a minimum of 150mins of moderate intensity exercise per week. This might sound like a lot but remember that even day to day activities like household chores, hobbies and caring for children count towards your weekly tally.

Change it up

Stick to a MIIT program (moderate intensity interval training) that mixes things up. Think aerobic training (walking, swimming, even some running) as well as strength and conditioning training (gym, pilates, yoga). And if all that exercise is making you weary, antenatal hydrotherap y can be a god send. As your pregnancy progresses, antenatal hydrotherapy is perfect for reducing load on your back, pelvis and hips while getting your heart rate up and ticking off some valuable exercise minutes.

Book an Appointment

If you would like more information, grab an appointment with one of our physiotherapists. They’ll guide you through a tailored exercise program that is safe and rewarding. If you'd like to join our antenatal hydrotherapy classes, give us a call. Bookings are essential.

It's Never "Just" an Ankle Sprain

nick.jones@mflphysio.com.au (Nick Jones) — Tue, 20 Jul 2021 06:42:57 GMT

Why you should get that sprained ankle looked at early.

Hydrotherapy or conventional physiotherapy?

Check out this 2024 study on what works best for high grade ankle injuries. The results might surprize you.

It’s “just” an ankle sprain. You hear it every weekend, at footy grounds, netball courts and hockey pitches all over this country (COVID permitting, of course!).

The thing is though, it is never “just” an ankle sprain. Here's why you might just want to get that twisted ankle checked out.

From gardeners to elite footballers, kids to the elderly, we’re all prone to ankle injuries. In fact, 70% of the general population will injure their ankle at some point during their lifetime. The most common mechanism is an inversion injury, where the foot rolls inwards (or inverts) and the ligaments on the outside of the ankle are torn. They are often referred to as a "rolled" ankle, or a "twisted" ankle and are one of the most common sports-related injuries seen by a physiotherapist.

More than 'just' an ankle

Often considered a benign injury (that is, not complicated or serious), ankle injuries cause a significant amount of time lost from sports and work, have a relatively high complication rate and have the highest incidence of reinjury of all musculoskeletal injuries. This places a huge financial burden on sports teams, workplaces and the economy. And it's NEVER just a ligament that is torn. Quite often there are multiple ligaments and tendons injured, some bone bruising, strained muscles, maybe even a fracture. You might have an inversion injury, an eversion injury or a high ankle (syndesmosis) sprain.

So why then, are they so under-rated?

Probably because they are so common. Many of us will have seen or even had a sprained ankle and so might feel confident managing an acute injury. The problem though, as mentioned above, is that lots of different structures can be injured, which impacts HOW the injury is managed and HOW LONG it takes to fully recover.

If you've injured your ankle, keep this in mind:

20% - 50% of people with a first time ankle sprain will develop long term problems, and you are twice as likely to reinjure the same ankle in the following 12 months!

That's not a great prognosis! Repeat injuries can progress to chronic pain, persistent swelling, ankle instability and ‘giving way’, and reduced functional capacity. That means less sport, less time in the garden, and more time away from work.

Early Assessment and Exercise

The research into management of ankle injuries shows that the earlier an injury is assessment and an evidence-informed management plan implemented, the better the outcomes. Early assessment allows for a clearer diagnosis and critical education, that can really speed up recovery times. Following the principals of PEACE and LOVE ( thanks British Journal of Sports Medicine for this great acronym! ) will help control the injury in the acute phase (days 1-3), and then progressively apply load through a holistic exercise program to challenge your strength, flexibility and proprioception. PEACE and LOVE is a great mantra, and fits nicely with the best evidence for managing soft tissue injuries just like this.

The solution

Every sprained ankle needs to be assessed, preferably early, by a suitably qualified professional and the best professional is a physiotherapist. Why? Because physio's are highly skilled in assessing and diagnosing the structures damaged when an ankle is sprained. They can refer you for an xray or an MRI if necessary, tape that ankle or put a brace or a boot on it for support, provide you with education about YOUR injury, and manage you to a full recovery with graded exercises and intervention to help you return to doing the things you love (or work!).

Remember, no two people are the same and no two ankles are the same. It's never too late to get that injury assessed and to start a tailored rehab program.

If your looking for some more information on the management of ankle injuries, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you have ankle pain or sprained your ankle? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, podiatrists, doctors and surgeons and can treat and manage your ankle injury or ankle pain with a personalised, goal-oriented and comprehensive management plan.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Give us a call now on 08 8945 3799 or click on BOOK AN APPOINTMENT (the green button down there on the right!) and we'll get you on the right track.

Antenatal Hydrotherapy

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 24 Jun 2021 02:35:44 GMT

Exercise during pregnancy is important for you and your baby

Keeping active and exercising during pregnancy is important for you and your developing baby. Antenatal hydrotherapy classes provide a social environment to help prepare expectant mums for their birth experience and recovery.

Benefits of hydrotherapy

Hydrotherapy has been used for thousands of years to revitalize, maintain and restore health. The warmth of the water allows tight muscles to relax and eases joint stiffness, while the buoyancy of the water supports your body weight, relieving pain and improving joint range of movement. There are many other benefits, which are great for pregnant women.

Prevent leg cramps, swelling and and varicose veins

Standing in water up to your waist is like wearing the perfect pair of compression stockings. The weight of the water creates a pressure gradient pushing against the legs. This pressure is greatest at the bottom of the pool around your ankles, where all that fluid wants to collect. The pressure of the water helps the veins to “pump” fluid from your legs back up to the heart, reducing swelling and leg cramps, and decreasing the pain associated with varicose veins.

Strengthen your pelvic floor

Exercising in water is low impact and great for your pelvic floor. During a pregnancy, as the baby develops, the pelvic floor muscles come under increasing stress. The stronger these muscles are, the better support for your growing baby and the less that load is shifted to the joints (ouch!).

During our hydrotherapy classes the physiotherapist covers pelvic floor education and exercises, which is a great way to learn about contracting and building your pelvic floor muscles. You'll learn where these muscles are, how to switch them on, even how to keep training them on land, all of which will help make your pregnancy more comfortable and enjoyable.

Soothe and strengthen your pelvis

If you are experiencing pelvic pain, then hydrotherapy is highly recommended. In fact, it is one of the best forms of therapy for pregnant women with pelvic pain.

Hydrotherapy helps with pelvic pain in three ways.

The heat of the water (maintained at between 33-35oC) helps tight muscles to relax;
The buoyancy of the water imparts a sense of weightlessness, taking the pressure off your pelvis and easing pain, and;
It allows some gentle therapeutic exercise to strengthen muscles around the pelvis.

Prepare your body for delivery

Like a lot of things in life, preparation is key. Pregnancy and childbirth can be taxing on the individual, and while there are many variables that can’t be controlled, this is something you can control.

Pelvic floor, strengthening and stretching exercises build your flexibility and strength while improving your cardiovascular fitness. This might help improve your breath control during a natural delivery, decrease your pain, or reduce the risk of pregnancy and childbirth-related incontinence. If you require a caesarean delivery, then these exercises are likely to improve your core stability in the post-partum period. Either way, you are likely to be more resilient and prepared for childbirth.

Antenatal Hydrotherapy

We offer small group (maximum of 6 participants) antenatal hydrotherapy classes for women in their second and third trimester of pregnancy.

Classes are held in our heated hydrotherapy pool at Coconut Grove on Wednesday evenings at 5pm. Each class is $33 and private health rebates can apply.

Classes are conducted by qualified physiotherapists with experience in women’s health and continence. Exercises include gentle cardio, stretching, strengthening, pelvic floor and deep abdominal exercises. The physiotherapist will discuss any concerns or issues you are experiencing and can tailor exercises to suit your fitness level and needs.

For more information or to book in for a class contact Movement For Life Physiotherapy on 08 8945 3799,

or book online by clicking on Book an Appointment.

What is it with Back Pain?

nick.jones@mflphysio.com.au (Nick Jones) — Thu, 10 Jun 2021 06:37:28 GMT

3 Important Facts About Back Pain

If you’ve ever experienced back pain, then you know how annoying, frustrating and debilitating it can be. Back pain is the 5 ^th most common reason for a visit to the doctor and, in 2018, was estimated to cost the Australian economy about $4.8 billion dollars!

Back pain is THE single most common complaint that physiotherapists see and treat. So we know a thing or two about it. And we want to break down some of the myths behind back pain. So here are 3 facts we think are important for everyone to know:

BACK PAIN IS COMMON

It is estimated that non-specific (common) low back pain affects somewhere between 75-84% of people at some point in their lifetime, and that 23% of adults worldwide have low back pain RIGHT NOW . Even adolescents have high levels of back pain, with estimates of 11-33% prevalence at any one time. A lot of this back pain is chronic, which means it has been present for longer than 12 weeks. These facts are not here to trivialise your experience with back pain, just to highlight the fact that there is a lot of it out there. And because there is a lot of back pain, there are a lot of opinions, approaches and philosophies on how to best treat it. Which brings us to the second point.

2. There is NO ONE WAY to fix back pain

The way our physiotherapists approach the management of back pain varies depending on YOU - who you are, what your personal goals are, what your lifestyle is like, and the type of back pain you have - acute (present for less than 6 weeks), sub-acute (back pain present for between 6 – 12 weeks), or chronic (back pain has been present for greater than 12 weeks).

Some people get better by doing nothing – they just need some guidance around resting a little, going about some normal daily activities, avoiding certain postures and maybe doing a little stretching. Others will swear that pilates or yoga is the way to manage back pain, while others still will say that manipulation “fixes” their back pain. The reason that different methods work (or don’t work) for different people is because…

3. BACK PAIN IS COMPLEX

I mean, really complex! Here’s a list of just some of the structures that could be contributing to your back pain - Muscle, ligament, tendon, joint, intervertebral disc, bone, blood vessel, nerve, fascia, central nervous system (spinal cord and brain).

What’s more is that there are so many REASONS that these structures might contribute to back pain, including how you hurt your back, how long you have had symptoms, how you move (your biomechanics), what your posture is like, your age, and the presence of co-morbidities (things like osteoarthritis, diabetes, cardiovascular disease).

Not only is every episode of back pain DIFFERENT , the SOURCES of pain can change over time. Talk about complicated! All of this needs to be considered carefully in order to develop a successful treatment plan.

So, where do you start?

Seek out Accredited Physiotherapy Clinics (like us!) that apply evidence-informed practice, understand the FACTS about back pain and can explain this to you in simple language! Knowledge is Power.

Make sure you get a treatment plan that is aligned with your goals, that is progressive, and is functional! Exercise and movement is still THE BEST MEDICINE for back pain

Recognise that lots of treatment approaches can be effective. Whether they ACTUALLY WORK depends on the ability to deliver these treatments at the right time, in the right way, and in the right volume.

Give us a call or book online RIGHT NOW if you want to see a physiotherapist that can get to the root of your back pain, takes a wholistic approach to your care and has a functional and goal-oriented approach to your recovery.

References

Thiese et al (2014). Prevalence of low back pain by anatomic location and intensity in an occupational population. BMC Musculoskeletal Disorders, 15, 283-294.

Returning to Running

Tue, 01 Jun 2021 04:27:18 GMT

Looking at getting back into running?

Running is a low cost, accessible solution to achieving better fitness, but it’s not as simple as just throwing on your joggers and hitting the track!

When we start any new fitness program, our bodies go through adaptive change. The ability of those tissues (think muscles, tendons, ligaments, and the cardiovascular system) to adapt successfully requires the load and volume of training to be slowly dialled up.

When we run, the load going through our knee joints increases by about 4.2 times our body weight. So if you weigh 80kg, the load going through the knee joint with every stride is about 336kg! Sounds like a lot, but our bodies are super clever and can adapt to these loads, even in the presence of degenerative changes. They just need time, and some TLC.

Looking to improve your fitness?
STOP! If you’re looking to get fit, and running is a part of that plan, there are a lot of factors to consider. Things like when you last ran consistently (6 weeks, 6 months or 6 years ago?), the type of running you want to do (sprints, interval, endurance), how old you are now, even the type of work you do. All of these factors influence how you should approach a running program.

If you work in a sedentary job or have been inactive for a period of time, you're likely to have reduced strength and flexibility. Doing some cross training and a dynamic stretching program will be a great adjunct to your running program.

Even if you've been active, your strengths might lie in different areas. Strong cyclists don't necessarily make for strong runners. The biomechanics differ significantly and so the load and control required in the lower limbs will be different.

Had an Injury?

If you’re on the comeback from injury, having someone who really understands the intricacies of that injury and how different tissues recover and behave makes a huge difference. The way that we tailor a running program for a muscle strain differs enormously to what we would do for an ankle sprain or knee joint pain. Physiotherapists use their knowledge of different tissues (muscle, tendon, bone, for example) and how they respond to load to develop programs that achieve your goals.

What are your goals?

Understanding your goals is another key factor. Maybe you want to improve your repeated sprints so that you are more competitive at netball, or perhaps you want to improve your times at park run, or have the Gold Coast marathon on your bucket list. These certainly require very different approaches, time frames and planning to succeed.

At Movement For Life Physiotherapy, we have designed running programs for marathon runners, elite hockey players, Thunder academy players and park runners. Regardless of whether we are working with a social runner, an amateur sportsperson or an elite athlete, our processes remain the same:

Take the time to learn about your running and sporting history
Screen you for risk factors for injury from running, including looking at your muscle strength, joint mobility and flexibility;
Develop achievable, time-oriented goals with you;
Tailor a program that suits your lifestyle.

Remember, just like no two people are the same, no two programs are the same.

If your looking for some more information on running, check out theses perspectives from the Journal of Orthopaedic Sports and Physical Therapy:

Do you want to get back into running or getting pain when you do go for a run? Give us a call.

We are part of a well-connected network of physiotherapists, massage therapists, podiatrists, doctors and surgeons. We're experienced with runners, can assess your running form and a provide you with a personalised, goal-oriented and comprehensive running and strengthening plan.

Call now on 08 8945 3799 or click on BOOK AN APPOINTMENT to book online.

Arthritis

Fri, 02 Oct 2020 05:28:40 GMT

Arthritis is a name for a group of conditions that affect the joints, causing damage that usually results in joint pain and stiffness. Arthritis can affect many different parts of the joint and nearly every joint in the body.

There are over 100 different types of arthritis and each type affects the joint and the individual person differently. Some types of arthritis only affect the local joint, while other types of arthritis can affect adjacent structures and other organs, such as the eye.

The most common forms of arthritis are:

Osteoarthritis
Rheumatoid Arthritis
Gout
Ankylosing Spondylitis

Arthritis doesn't discriminate. It affects people of all ages, backgrounds, gender and lifestyles. Approximately two thirds of people with arthritis are aged 15-60 years, and affects people of all ages, not just the elderly. While arthritis does affect people differently dependent on the type of arthritis present, commonly signs and symptoms are:

Joint pain and swelling
Stiffness and/or reduced movement of a joint
Redness over the joint, often accompanied by and warmth to the touch
General symptoms, such as fatigue, loss of weight or feeling unwell.

If you think you might have arthritis, it is recommended that you consult with your doctor. Once a diagnosis has been made, the management of arthritis requires a multi-disciplinary approach that includes pain relief, physiotherapy, hydrotherapy and exercise therapy.

There is not currently a cure for arthritis. However there are many effective strategies for reducing the pain and discomfort associated with arthritis, permitting people with arthritis to continue to lead an active, healthy and enjoyable lifestyle. Studies have shown that movement, or therapeutic exercise, is regarded as the best form of treatment for arthritis. Through individually designed programs, your physiotherapist can help keep your joints and muscles active, while providing you with home exercise tools to improve overall quality of life.

At Movement For Life Physiotherapy we can help you understand how arthritis affects you, while getting you moving, stretching and strengthening affected and surrounding join ts. Consult with one of our physiotherapists today to learn more about what you can do to help manage your symptoms, maintain your strength and joint function and keep moving, for life.

Headaches

Fri, 02 Oct 2020 05:25:20 GMT

Headache disorders are amongst the most prevalent and disabling conditions worldwide.

Headache affects people of all ages, races and socioeconomic status and is more common in women. The World Health Organisation estimates that 50% of the population globally has experienced a headache in the past year. While most headaches are mild and can be self managed, some headaches can be extremely debilitating and have significant impact on an individual’s quality of life, imposing huge costs to healthcare and indirectly to the economy in general.

The vast majority of headaches can be effectively treated by a General Practitioner, utilising pharmacological and, where indicated, physiotherapy intervention. In most instances, with correct clinical diagnosis, special investigations and specialist input are not required.

Headaches can be broadly classified into either primary or secondary headache.

Primary headache

Primary headache disorders constitute nearly 98% of all headaches. Primary headaches are distinct headache disorders that occur on their own and are not the result of another health condition. Primary headaches include:

Migraine
Tension-type headache (TTH)
Trigeminal Autonomic Cephalgias (TACs)
Other primary headache disorders.

Secondary Headaches

Secondary headaches are less common but important to recognise as they can be serious and may be life threatening. Secondary headaches sometimes present with signs and symptoms referred to as "red flags". Click here to see a list of red flag symptoms for secondary headache and if you think you have any of these symptoms, please consult your doctor immediately.

Secondary headaches can be caused by:

Trauma or injury to the head and/or neck (eg. concussion, whiplash)
Cranial or cervical vascular disorder (eg. stroke, cerebral venous thrombosis)
Non-vascular intracranial disorder (eg. tumour, epilepsy)
Substance exposure or its withdrawal
Infection (viral, bacterial, or fungal infection)
Disorder of homeostasis (eg. Diabetes, hypertension)
Disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cervical structure

While most headaches can be well managed with minimal input from a health professional, some types of headaches respond well to physiotherapy intervention. In particular, tension-type headaches and headaches related to cervical spine injuries and/or degenerative changes in the neck, known as cervicogenic headache. For more information these types of headaches, click on the links below.

Cervicogenic Headache

Tension-type Headache (external link)

For in-depth information on types of headaches, head to The International Classification of Headache Disorders 3rd edition .

Do you have neck pain and a headache, or have symptoms of a tension-type headache?

Give us a call. We are part of a well-connected network of physiotherapists, massage therapists, doctors and surgeons

and can treat and manage cervicogenic and tension-type headache with a personalised, goal-oriented and comprehensive plan.

Call now on 08 8945 3799 or book online.

Muscle Strains

Fri, 02 Oct 2020 05:20:46 GMT

A muscle strain, or muscle tear, is a common injury caused by over stretching or exerting a muscle.

They vary from being mild to severe and are commonly associated with bleeding, swelling and difficulty using the affected area. There are other causes of muscle pain though, such as blunt force trauma (corky) and delayed onset muscle soreness (DOMS, the pain you get when you commence a new exercise program) which is why it is important to get muscle strains assessed early to ensure the correct management plan.

Depending on severity, strains can take anywhere between 7-10 days to 3 months to fully repair. The best management is early management. Our physiotherapists can accurately diagnose the severity of muscle strains and advise how to effectively rehabilitate it, including return to sport or return to work plans.

Joint Injuries

Fri, 02 Oct 2020 05:20:45 GMT

The shoulder, elbow, wrist, hand, hip, knee, ankle and foot are all susceptible to injury, whether that be through trauma or overuse.

Traumatic injuries include a fall or sporting accident, a sprained ankle, shoulder or knee cap dislocation, or a ligament tear, such as an ACL. Overuse and overload injuries include tendon problems such as Achilles tendonitis, joint pain associated with arthritis, and tennis elbow, a painful condition affecting the outside of the elbow.

Our physiotherapists are skilled at diagnosing and treating joint problems, and use a clinical reasoning framework to develop the best course of treatment, including management strategies and tips to avoid a recurrence in the future. We stock a large range of braces and supports and can refer for investigations such as an x-ray or MRI when required.

Neck Pain

Fri, 02 Oct 2020 05:20:41 GMT

Neck pain is a very common condition that can also contribute to headaches , shoulder and upper back pain .

The neck is designed for a lot of movement so that we can move the head independent of the body position below it. To do this, it gives up some stability. As a result the neck is prone to chronic overuse injuries (such as poor posture), repeated microtrauma from sport and acute deceleration injuries such as whiplash.

Our physiotherapists will talk to you in depth about your neck problems to accurately diagnose your problem. They will assess your range of movement and strength, and work with you to plan a suitable course of treatment.

To learn more about conditions that affect the neck, click on one of the blog topics under neck.

Vertigo

Thu, 01 Oct 2020 05:20:49 GMT

Vertigo is a common, distressing condition that is classically described by a person as a ‘spinning’ sensation of either their body or their surroundings.

While there are many causes of vertigo, the most common cause, Benign Paroxysmal Positional Vertigo (BPPV) is treatable by a trained physiotherapist and can have immediate positive outcomes.

We recommend that if you have vertigo you request to see a physiotherapist trained in the management of this condition. Your physiotherapist will be able to assess and treat you using specific techniques, or if required, refer you to see a medical doctor for further investigation or assessment.

Back

Tue, 21 Jul 2020 03:46:22 GMT

Back pain is extremely common, affecting 80% of people at some stage in their lives.

In addition to localised pain, the lower back can also refer pain to the hip, groin, leg and foot. Spinal discs, muscles, ligaments, bones and nerve tissue can all contribute to back pain.

The causes of back pain can include:

Poor posture.
Prolonged or repetitive sitting, bending or lifting.
Weakness due to lack of exercise or being overweight.
During pregnancy.
Trauma such as a falls, sporting collisions or a motor vehicle accident.

The good news is we can help. Our Physiotherapists use a clinical framework model to accurately assess and manage both acute and chronic back pain. Our physio’s will provide you with strategies and treatment options to reduce your pain, improve your strength and flexibility, and achieve your goals.