Category: Education

Orthotics are shoe inserts used for correcting the biomechanics of your feet where it is that your foot mechanics are causative or a part of the reason for your presenting complaint. This commonly includes heel (spurs, plantar fascia, Achilles tendon), knee, hip or lower back complaints.

I have an arch, I don’t need orthotics do I?

Orthotics can be for people with all foot types. We think of them as a device to control your foot’s motion to within normal limits. They are not designed to stop normal motion but reduce or control excessive motion causing potential harm.

The biomechanics of the foot are very important for the optimal functioning of the rest of the body when you stand and walk. If your feet aren’t well positioned or moving optimally the effects can be felt not only in the feet but up your body. The foot should be in what is known as a neutral position where the foot bones sit nicely on one another. This position lies between a pronated (flat foot) and supinated (very high arch) position. Pronated feet are very common in today’s world where we are always walking on hard, flat surfaces that offer no support to the arches of our feet. Increased body weight also puts more pressure through the feet from above and often leads to a flattening effect. Do you have an arch lying down that then disappears when you stand on your feet or a very large arch that perhaps moves too much in walking?

The arch in the foot is an important structure that allows mobility and shock absorption on impact with the ground but also locks into a solid position that creates a spring effect in walking and running. When the arch flattens it leads to other parts of the body to compensate and become overloaded, leading to injuries. A common issue we see with pronated (flattened arch) feet is calf pain as your calf must work harder in the pushing off phase of walking because the arch doesn’t have the normal spring effect. Another common problem is knee pain. This results from the bones in the feet rolling inwards and out of alignment resulting in the knee joint to also point towards your midline. This position can lead to uneven pressure on the knee joint and patellar (kneecap) tracking problems.

Can’t I get them from the Chemist or shoe shop?

The orthotics we prescribe may appear similar to some orthotics within these retail stores but, generally these retail orthotics lack the degree of rear-foot control of our medical grade devices. Many of the ‘orthotics’ available off the shelf within these stores are not for foot control but shock absorption and therefore have little effect on fixing the problem. Simply pick them up and try to bend the inside of the orthotic where the heel cup moves into the arch of the foot. This is the crucial area for many true orthotics and should therefore be difficult to move, resisting excessive motion of your foot.

In short, off the shelf orthotics are generally very soft, don’t last long and are a one shape fits all rather than custom made to your foot and your biomechanics. This therefore requires anatomical knowledge and a good understanding of biomechanics to ensure prescription and fitting doesn’t result in a secondary problem. Often we see people with problems stemming from poorly fitted orthotics within retail stores, many who have invested a fair bit of money chasing different shoes and inserts to find the answer. We are all different and require individual prescription. Some will need extra adjustment (wedging, doming, firmer/softer, full length, 2/3 length) and hence our physio’s are best to give you advice re your footwear, orthotics and individually prescribe and shape your orthotic. The orthotics we use are heat moulded to your feet to position them (and the lower limb) into a neutral alignment.

What about the Podiatrist?

Orthotics from a podiatrist on the other hand are quite rigid and are custom made from scratch to the shape of your foot and are made very precisely. These are often quite expensive and can be uncomfortable for athletic pursuits. It is also extremely important that should you see a Podiatrist they have a greater knowledge of the body’s biomechanics and will take into account more than just our foot. If your feet require more than what we provide, we can refer you to an excellent team of Podiatrists who we trust to provide you with an orthotic that takes into account more than just your foot.

What are your Orthotics like?

The orthotics our physiotherapists fit lie somewhere in between retail stores and Podiatry orthotics in more way than one. They are inexpensive, rigid and are moulded to the shape of your foot.

If you have flat feet, or think you might need orthotics, come in and see us to get fitted and put you on the right track. There’s more to addressing your mechanics than orthotics alone. Evidence shows orthotics and a combination of other interventions (stretching, strengthening, education around movement habits) have a greater outcome than orthotics alone. Book your appointment now.

Written by: Scott Ward

Workplace Strains & Repetitive Strain Injuries

Do you experience soreness that becomes more noticeable by the end of the day or the end of your working week? This is how Repetitive Strain Injuries (RSI) behave in the early days of the injury. Then, with a weekend or few days off work, the symptoms calm down… only to return when work resumes.

RSI is an overload injury, caused by repeated movements that cause strain on the soft tissue which exceeds the body’s ability to recover. This causes inflammation which stimulates the sensation of discomfort. Over time, as the daily work demands continue, the pain increases to the point of creating pain and weakness. This weakness is often due to pain inhibition, which is not a true weakness but rather the body’s way of protecting itself from further harm.

The typical areas affected by RSI, in the office worker, include the forearm and elbow (e.g. tennis and golfer’s elbow), the wrist (e.g. carpal tunnel syndrome), the shoulder (e.g. impingement syndrome). Other areas include the neck, upper and lower back and the shoulder blade area – typically these are muscular pains that can feel great when applying heat or massage to the area.

If you are currently experiencing aches and pains that may be as a result of your work it is best to make a physiotherapy appointment sooner rather than later. Dealing with an injury that has been around for months is harder to settle than one that has only been there a short period of time.

Your physiotherapist can help with treating the symptoms and providing you with clear advice on how to alter the workplace to avoid irritating the condition – hence providing the injury with best environment to settle. Little changes to the workplace may include altering how you sit, the type of mouse/keyboard you use, advising on exercises and taking micro-breaks from your work. To assist with severe cases of RSI a more intensive approach may be required, including adjusting what you do outside of the workplace, addressing your sleep pattern, and introducing certain types of cardiovascular exercise into your week. Discussions with your GP may be required should scans or medication be required

Written by: Austin Wiehahn

ICE, RICE, PRICE, POLICE, PEACE & LOVE or UNLESS?

What am I talking about? Find out here. Maybe you have a suggestion to add to the list.

The RICE principle has transitioned from RICE to PRICE to POLICE to now PEACE & LOVE.

Rather than trying to describe it all in words, I’ve attached the source, a really short editorial piece explaining each of the letters of the acronym, PEACE and LOVE. Click here to read the article.

The greater question you may be wondering is:

So don’t I use rest, ice, compression and elevation the area after I hurt myself?

The answer is likely no, well to some degree! It appears that once we have ruled out anything requiring referral for emergency medicine (fracture, dislocation, etc), that we need to get rid of or decongest the area of injury by using the lymphatic system. The lymphatic system relies on the pumping of muscles and breathing to rid our system of the “rubbish” produced after injury. Therefore often early mobilisation of the area is helpful.

Ice itself though, was proposed for anti-inflammatory benefits. However, we need some inflammation for healing to occur. Ice can be useful for making the area feel better (see paper attached). Unfortunately the penetration of topical ice is unlikely to change the muscle temperature to accepted levels required to have a metabolic effect, hence it’s application remains mainly for pain relief. This can be provided in some ways more effectively though than by others (click here to read which ice application technique may be best).

Compression of the area may reduce swelling, but in many regions the compression created by adjacent muscle contraction can produce greater pressure differences than external compression. This is evidence to support the avoidance of absolute rest.

Elevation is good to do, but has relatively low evidence. It is normally recommended because it has low risk and some benefit. Often the combination of elevation with muscle contraction is the most effective means of reducing swelling.

Therefore a combination of two new acronyms has been proposed to optimize recovery.

Immediately after a soft tissue injury, do no harm and let PEACE guide your approach

After the first days have passed, soft tissues need LOVE

Someone also recently chimmed in with another acronym for treatment of these soft-tissue injuries. Here, is how it goes;

“Is it now UNLESS?

Well RICE was nice
and PEACE & LOVE suffice
but UNLESS you do your rehab well
you’re gunna pay the price…

Unload – first do no more harm
Nurture – let it heal with sensible time frames
Load – gradually load the area with suitable tasks
Exercise – maintain general exercise for fitness and stamina
Strengthen – ensure you regain adequate strength and endurance
Skill – proprioceptive and sports specific high level function”

What are your thoughts? Perhaps you could throw some suggestions our way for how it should go. What is for certain is the acronym of do no HARM after an injury. That means no Heat, Activity, Alcohol or Massage for the first 48-72 hours (keep in mind though, not complete rest J).

Compiled by: Scott Ward

References:

1. Blaise Dubois et al. (2020). Soft tissue Injuries simply need PEACE & LOVE British Journal of Sports Medicine, 2020. 
2. Herrera et al (2010). Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Hysical Therapy 90 (4): April 2010: 581-591.
3. Caswell, D. The Prehab Guys. The truth about icing injuries. Cited 20^th November 2020, https://theprehabguys.com/the-truth-about-icing-injuries/

Repetitive Strain Injuries (RSI), are common injuries that can affect both the upper and lower limbs and even the back and neck regions. Yes, even the spine, how many times have we felt back pain after a heavy bout of gardening or home DIY? This is a repetitive strain injury as a result of overdoing an activity and can affect the muscles, tendons or nerves in the affected region.

Most people have heard of RSI and would immediately think of injuries such as tennis elbow or golfer’s elbow. These are probably the most researched injuries and the literature abounds with information about these 2 injuries. It might surprise you that tennis elbow is often unrelated to playing tennis and non-golfers can be afflicted with golfer’s elbow. Interestingly injuries to the lower limb such as achilles tendonitis, plantar fasciitis and shin splints are also types of RSI – we will discuss these another time. This blog will focus on the upper limb.

What is a repetitive strain injury? Well, it is an overload injury to the soft-tissues (e.g. tendons, muscles and/or nerves). An overload injury means that a stress has been applied to the soft-tissues repeatedly or constantly and this accumulation of stress outweighs the tolerance of the soft-tissue. So, for example, typing is an activity that places some stress (albeit a very low-level stress) on soft tissues in the forearm, wrist and elbow. Whilst the soft tissue can handle a certain amount of stress, asking it to tolerate increased stress repeatedly may start to overload the tissue cells and cause microtrauma. This results in a ‘low grade’ inflammation that manifests as a slight soreness that is not too much of a bother. It is only when the stress is continued that the inflammation causes more soreness to the point when the person decides they have a real problem and seeks help.

Let’s go through the biomechanics of typing: muscles create the finger movement or wrist posture and the muscles attach to bones via tendons. By raising a digit to press on a key the muscle pulls on the tendons to lift the finger and the tendon relays that stress to the bone. All along the muscle, tendon or the tendon attachment-point into the bone, stresses are being exerted. Now pretty much all of us can type for long periods of time without issues. Let’s say that an individual has a poor technique at the keyboard and places more stress through their forearm than someone else – they have a greater chance of getting an RSI. Let’s add in another variable, workload, what if there was a surge in workload? Again, the risk is increased. Let’s keep adding stresses: the task of data entry – repeated use of only a few keys (hence reduced task variability)… Work stress, a short turnaround time for the work to be completed – all of a sudden the soft-tissues have to tolerate a higher volume of stress. What if the person has poor sleep patterns (e.g. parent to a newborn child) – less time to recover…how about a co-morbidity (e.g. diabetes or heart disease) – so the ability for that person to recover is less efficient versus a fit and healthy individual. There are hundreds of variables that might cause one person to get RSI versus another person…and vitally why some people recover faster than others. The information and answers people search for on Google are too generic for most people – the information may be ‘sort of’ correct…but does not take into account the person and the numerous variables that might be impacting on the recovery.

How does a physiotherapist at Nelson Bay Physio manage someone with a suspected RSI? This starts with making an accurate diagnosis through careful history taking, observation and testing. Occasionally a scan or investigation may be required but often this is not required. The background history to the injury is paramount in how we manage the injury. Applying therapy to the injury site is helpful in dealing with the symptoms, addressing the contributing factors to the injury is paramount in settling the condition and preventing the likelihood of relapses.

So how can you expect your physiotherapist to manage your injury? This may involve several of the following:

• Providing local treatment to the injured area.
• Splinting the joint in certain circumstances and normally only in the inflammatory phase of the injury
• Providing you with copious amounts of advice regarding how you can alter your working posture and tasks (i.e. ergonomics)
• Addressing any postural issues
• Advising on and providing ergonomic equipment
• Reviewing your workplace and workplace habits if necessary
• Analysing your daily tasks – basically everything that you do that may impact on your injury

Remember, one size does not fit all.

So when should I seek help if I am getting twinges?

Having the problem assessed early makes it easier to treat. If the episodes of discomfort are becoming more frequent and more uncomfortable…and less able to settle naturally on your non-work days or rest days…seek help. Leaving it beyond this point simply means it will take longer to recover and may mean more drastic measures need to be taken.

Written By: Austin Wiehahn

The answer is easy! Ring and book-in, we can help you.

2019 World Physiotherapy Day – Sunday 8th September

People who have chronic pain often tell us that it can be difficult to get or stay active. But physiotherapists can suggest activities or an exercise program that are right for the individual experiencing chronic pain. They can help understand how pain works, reduce fear around pain, educate about your condition, encourage safe participation in physical activity, build confidence, help return to remain at work or participate in activities that allow you to live life to the fullest.

This year we were promoting our role in chronic pain during World Physiotherapy Day via our facebook account. The campaign was focused around the following key messages about the benefits of using exercise to manage chronic pain and:

• maintain flexibility and movement
• improve cardiovascular health
• build and keep muscle tone
• improve mood and general wellbeing
• help control pain
• increase confidence to take part in activities
• take back control of your life and reduce your fear

Greater Trochanteric Pain Syndrome or Hip ‘Bursitis’?

Greater Trochanteric Pain Syndrome (GTPS) is a term used to describe the condition previously often inaccurately diagnosed as trochanteric bursitis.

Bursae are fluid filled sacs that provide cushioning between bony prominences and overlying tissues. Trochanteric bursitis was previously used to indicate inflammation of the bursa of the lateral hip that are located between the greater trochanter (bone on the outer hip) and the overlying gluteus tendons (buttock muscles), iliotibial band (ITB) and tensor fascia lata (TFL).

A clinical diagnosis included both an aching lateral hip pain and distinct tenderness around the greater trochanter, pain on moving the leg to the side, pain when lying on that side, pain with prolonged standing, and pain increased by walking and running.

Epidemiology studies suggest that these symptoms are a common complaint amongst active and sedentary individuals, have a higher prevalence in women (4:1), are most commonly found in those 50-70 years of age and have no racial predilection.

Trochanteric bursitis may be classified as either an acute injury or a repetitive irritation. Acute injuries may occur due to impact from falls, sports or other high impact trauma. Repetitive traumas are usually due to irritation from the friction of the iliotibial band (ITB) rubbing over the trochanter during continuous flexion and extension of the hip. This type of irritation is most often seen in runners, however is not exclusive of less active individuals.

The term ‘trochanteric bursitis’ has been substituted for GTPS as current research using ultrasound and medical resonance imaging highlights a paucity of evidence supporting the inflammatory process of the condition. This evidence also identifies that in the majority of patients with pain and tenderness over the greater trochanter, the bursae are not involved, emphasizing instead tendinosis or tears of the gluteal muscles as the primary cause of the pain. These signs and symptoms are often secondary to other pathologic conditions that have been caused by biomechanical deficiencies that can be treated with physiotherapy.

Conditions that may be causative of GTPS include;

• Chronic mechanical low back pain
• Degenerative arthritis or disc disease of lower lumbar spine
• Degenerative joint disease of knees
• Patellofemoral pain
• Fibromyalgia
• Iliotibial band syndrome
• Inflammatory arthritis of the hip
• Ipsilateral or contralateral hip arthritis
• Anterior hip impingement
• Leg length discrepancy
• Obesity
• Pes planus or excessive pronation
• Tendonitis of external hip rotators
• Total hip arthroplasty
• Hip abductor weakness

All of these factors can be treated and improved with physiotherapy. Whilst cortisone injections into the hip can reduce your pain, they do not fix the underlying biomechanical deficiency and therefore without correction many people develop chronic hip or other secondary problems. Cortisone can be used to decrease pain and therefore allow physiotherapy to correct underlying deficits. Present to your physiotherapist today for a full assessment and correction. We will direct you appropriately should we feel that a local injection will make your rehabilitation easier. Ultimately avoid an injection until you try conservative management.

Written by Scott Ward

When should you see a Physiotherapist for your ankle sprain?

Ankle sprains (rolled ankles) are one of the most common musculoskeletal injury. Most people think that a sprained ankle is a minor injury that will resolve on its own. However, research has shown that symptoms such as pain, swelling, reduction in range of motion and instability, persist in up to 30% of cases. This can lead to a reduction in exercise, sport and daily activities and can become a major burden in one’s life. Management is generally conservative which can involve immobilization, strapping, strengthening, balance training, joint mobilization, massage and jumping and landing practice.

It is beneficial to see a physiotherapist early after your injury for many reasons:

• The first reason is to ensure there is nothing fractured or anything sinister going on in your ankle such as a syndesmosis or joint surface injury. A physiotherapist is the best judge of what your specific injury requires, whether that be further investigation with scans, immobilization or early mobilization.
• There is also a high rate of re-injury with ankle sprains. If you have rolled your ankle, you are at a higher risk of doing it again and the more you do it, the more unstable it becomes. An ankle sprain will require exercises to improve stability and increase control of your ankle in everyday and athletic tasks. Therefore, if you see a physiotherapist, even for a minor injury, we can set you on the right path for prevention of further injury or re-injury in the future.
  Seeing a physiotherapist for early treatment on an ankle sprain has been shown in multiple studies to have a positive effect on pain, function and swelling when compared to a delayed treatment. Early assessment and treatment result in a quicker return to function and fast-tracked rehabilitation process. This will lead on to strengthening, balance and return to work/sport specific exercises so you perform at your best.

If you sprain your ankle come in and see us so we can make sure you get the best treatment for your specific injury. We will ensure you are assessed properly and get the right treatment to get you back to what you love doing as soon as possible. Read the evidence below to know what’s best for your ankle and why seeing a physiotherapist is evidence-based.

Current Evidence for Ankle Sprain Treatment

Here is the highest level of evidence available regarding the treatment of ankle sprains. The points below confirm that if you injure your ankle don’t sit around at home, come and see us and get back on your feet earlier with less chance of future injury. Remember you don’t need a Dr.’s referral. Until then R.I.C.E.!

• There are no indications that the use of ice on its own is effective₍₄₎

• Intermittent application of ice will reduce pain more than with standard application of ice₍₄₎

• Ice combined with exercise therapy decreases swelling in comparison with heat₍₄₎

• Those receiving physiotherapy intervention made significant improvements compared with those just receiving R.I.C.E. at both 6 weeks and 3 months post injury₍₃₎

• Functional treatment (elastic bandaging, soft casting, taping or orthoses with associated coordination training) for 4 to 6 weeks is preferable to immobilisation in a cast for outcomes_(1,4)

• Lace-up supports (braces) are more effective than elastic bandaging_(1,4)

• Using a brace or tape reduces the risk of recurrent inversion injuries in those who are active in sports₍₄₎

• It is unclear whether a brace is more effective than a tape. Therefore it comes down to individual preference. It is recommended to use a brace or tape to prevent a relapse₍₄₎

• Exercise therapy, training coordination and balance, prevents recurrence in the long term (up to 12 months) and should include proprioception, strength, coordination and function maintenance₍₄₎

• Exercise therapy should be included as much as possible into regular activities to prevent recurrences₍₄₎

• No recommendations can be made concerning the type of shoes to prevent recurrence of ankle ligament injury₍₄₎

• There is a role for surgical intervention in severe acute and chronic ankle injuries, but evidence is limited. Functional treatment is preferred over surgical therapy₍₄₎

Written by: Scott Ward & Lachlan Oberg, Nelson Bay Physiotherapy & Sports Injury Centre

References

Bleakley, C.M., O’Connor, S.R., Tully, M.A., Rocke, L.G., MacAuley, D.C., Bradbury, I., Keegan, S. and McDonough, S.M., 2010. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. Bmj, 340, p.c1964.

Hubbard T &.Hicks-Little C.A. Ankle Ligament Healing After an Acute Ankle Sprain: An Evidence-Based Approach. Journal of Athletic Training 2008;43(5):523–529.

Hultman K, Falstrom A & Oberg U. The effect of early physiotherapy after an acute ankle sprain Advances in Physiotherapy, 2010; 12: 65–73.

Kerkhoffs G.M., Van den Bekerom M. & Elders, L.A.M. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. British Journal of Sports Medicine 2012 46: 854-860.

Lin, C.W.C., Hiller, C.E. and de Bie, R.A., 2010. Evidence-based treatment for ankle injuries: a clinical perspective. Journal of manual & manipulative therapy, 18(1), pp.22-28.
Hultman, K., Fältström, A. and Öberg, U., 2010. The effect of early physiotherapy after an acute ankle sprain. Advances in Physiotherapy, 12(2), pp.65-73.

Seah R. & Mani-Babu S. Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence. British Medical Bulletin 2011; 97: 105–135

It’s Winter and often with it comes an increase in the number of children participating in contact sports. Did you know that concussion is a from of traumatic brain injury and it can occur even without contact to the head? Please prepare yourself for the care of your child by clicking and reading this link to an article by Gemma Nisbet in The West Australian. Gemma discusses the matter with paediatric physiotherapist, Nicole Pates. Your physiotherapist may then have a role to play in the assessment of any suspected concussion using an administration tool specifically designed to do so, named the SCAT5 or Child SCAT5. More can be found at the Sports Medicine Australia website and it is important to note that different sports have different policies regarding concussion.

A new decision support tool for patients suffering with osteoarthritis (OA) of the knee has recently been developed. The tool will provide evidence-based information to assist you in making more informed decisions by identifying treatment options, including the risks, benefits and cost. Find out more about this comprehensive tool by clicking here. Remember to also read our previous documents regarding how to future proof your knees and learn why arthroscopic knee surgery for degenerative knees is not recommended. Come and see the physiotherapist for the best advice and outcome for prevention, prehabilitation and rehabilitation around joint replacement. The evidence supports a better outcome.

As physiotherapists we often get asked whether the application of heat packs or ice packs is more useful for all sorts of injuries. The answer isn’t black and white. It depends on your injury, what stage of healing you’re up to and what your preferences are. Typically, an acute (fresh or new) injury will respond better to icing and a chronic (older or persistent) injury will like heat. However, there are exceptions and the effectiveness of both is up for debate.

What does heat do?

Physiological effects of heat therapy include pain relief, increases in blood flow, metabolism and elasticity of connective tissue. Increasing blood flow and metabolism is thought to promote healing by increasing the supply of nutrients and oxygen to the site of injury. Increased elasticity can lead to improvements in range of motion.

When should I use heat and how do I do it?

Heat therapy is good for muscle spasm, joint pain and chronic pains. Heat should be avoided when inflammation is present as it can make it significantly worse. It is good for back pain, osteoarthritis and general muscle soreness. Heat can be applied via a heat pack, hot water bottle or via hot water such as a bath or shower. Heat should not be applied to an infection, acute injuries or flare ups of arthritic joints. It is best applied as a comfortable even warmth for some 20-30 minutes and can be applied whenever you are able.

What does cold do?

Cold therapy decreases blood flow which is thought to reduce swelling and slow the delivery of inflammatory mediators, reducing inflammation of the affected area. Interestingly, this is most effective when combined with elevation and compression. Most importantly, it induces a local anaesthetic effect by decreasing the activation of nociceptors and the conduction velocity of nerve signals conveying pain.

When should I use cold and how?

Cold therapy is best used for acute injuries. Back pain generally prefers heat rather than cold and is an exception to this rule. It is best applied with an ice pack, frozen peas or massaging with an ice cube. If using an ice pack or frozen vegetables it is best to wrap in a moist towel and apply for 20 minutes at a time every 2 hours. If massaging directly with ice, rub your skin for a few minutes or until the area becomes numb. Cold therapy should not be used in patients with cold hypersensitivity, cold intolerance, or Raynaud’s disease, or over areas of vascular compromise.

Heat and cold therapy will not have a huge effect on your recovery from an injury, though they do have a recognized effect for decreasing pain. A reduction in pain can, however, allow you to start moving earlier which is important for all injuries. If you are torn between using cold or heat, try them both and see which you prefer. Use whatever feels the best to you.

Should you need a hot or cold pack please pop in. We have varying options readily available for your immediate relief.

Written by: Lachlan Oberg

References:

Moody, J. Heat Vs Cold Therapy- Which One Should I Use? https://www.physioinq.com.au/blog/cold-vs-heat. 2016

Ingraham, P. The Great Ice Vs Heat Confusion Debacle. https://www.painscience.com/articles/ice-heat-confusion.php. 2017

Ingraham, P. Heat for Pain. https://www.painscience.com/articles/heating.php. 2016

Ingraham, P. Icing For Injuries, Tendonitis, and Inflammation- Become a Cryotherapy Master. https://www.painscience.com/articles/icing.php. 2017

Gerard A. Malanga, Ning Yan & Jill Stark (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury, Postgraduate Medicine, 127:1, 57-65, DOI: 10.1080/00325481.2015.992719

What are we as physiotherapists doing when we push on your back?

We are performing a technique known to us as a PAIVM or passive accessory intervertebral movement. A PAIVM involves a small movement of one vertebrae in relation to the vertebrae above and/or below. We use this technique as an assessment and as treatment.

In assessment we push on segments of your back and are feeling for the amount of movement and the feel of this movement i.e. is it stiff or loose.

In treatment we are trying to stretch the fibrous tissue surrounding each particular joint and desensitize the area. Research has shown that PAIVMs can have a significant effect on pain and range of motion. It is useful for those with pain, stiffness, temporary jabs of pain and some specific disorders of the back.

So if you have any stiffness or pain in your back, come in and see us so we can relieve you’re pain/niggle and get you moving better.

Better still, lets find out the reason for it and see if we can stop it happening again.

Written By: Lachlan Oberg

References

Manual Therapy Techniques For The Lumbar Spine. (2018, June 8). Physiopedia. Retrieved March 8, 2019 from https://www.physio-pedia.com/index.php?title=Manual_Therapy_Techniques_For_The_Lumbar_Spine&oldid=189931.

Abbott, J. H., Flynn, T. W., Fritz, J. M., Hing, W. A., Reid, D., & Whitman, J. M. (2009). Manual physical assessment of spinal segmental motion: intent and validity. Manual therapy, 14(1), 36-44.

Fundamentals Of Maitland Mobilizations. Hall, S. J. Retrieved March 8, 2019 from http://morphopedics.wikidot.com/fundamentals-of-maitland-mobilizations.

Frozen Shoulder also known as Adhesive Capsulitis is a musculoskeletal condition affecting range of movement and resulting in pain in the shoulder joint for long periods of time (generally 9 months to 2 years in duration).

This condition can occur as a result of immobilisation, trauma or spontaneously for no apparent reason and it is for this reason that its prevention is most difficult. What we do now is that there are several conditions that have a higher prevalence for frozen shoulder, including diabetes and female between 40-65 young.

It presents firstly as an insidious onset of pain that progressively worsens and a gradual decrease in movement in all directions.  People have sharp pain with end range movement and pain at night. Often people have trouble with overhead activities, dressing and reaching behind the back. Frozen shoulder may however mimic other conditions of the shoulder in its early stage, such as rotator cuff dysfunctions, subacromial impingement/bursitis and osteoarthritis.

Frozen shoulder presents as 3 phases:

1. Freezing/painful: gradual onset of pain at rest and sharp pain at end range movements and night pain
2. Frozen/ stiffening: pain remains and shoulder loses range of movement before pain starts to subside
3. Thawing/ resolution: range of movement starts to improve

This is a self-limiting disease meaning it will get better by itself. There are a few strategies often employed to break these adhesions (hydrodilatation, manipulation under anaesthetic and operative capsular release) but despite their application, many people return to a “frozen” state some months later. Recovery times range between 6 months to several years.

Physiotherapy treatment is beneficial for patients with frozen shoulder. The treatment depends on the phase the patient is in and their particular symptoms and functional ability. A physiotherapist can diagnose and explain the condition, provide pain relief and maintain and/or improve range of movement depending on stage.

Article By: Lachlan Oberg

References:

1. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med. 2008;1(3-4):180-9.
2. Adhesive Capsulitis. (2019, February 4). Physiopedia, Retrieved March 6, 2019 from https://www.physio-pedia.com/index.php?title=Adhesive_Capsulitis&oldid=204318.

A wonderful professional development session today was enjoyed with Pelvic Form Physiotherapy’s Amy Hansen discussing all things pelvic floor.

Did you know that:

• 75% of women experience prolapse at some point in their life
• 40% of men in their 40’s have erectile dysfunction (and this statistic increases by 10% for every decade).
• It is estimated that 65% of women and 30% of men who visit the GP are affected by incontinence, yet more than two thirds don’t discuss it!
• Pelvic pain, pain during intercourse and incontinence are not normal so see a physiotherapist for help.
• Surgery is a last option and should only be considered after conservative management and physiotherapy.

There is a lot of evidence for physiotherapy management of incontinence, retention, defacation disorders, pelvic girdle pain, antenatal and postnatal care, cancer rehabilitation, pre and post prostatectomy and erectile dysfunction. The concern is people don’t come forward and seek help and often get referred to a surgeon before anything else.

You don’t need a referral to see a physiotherapist privately.

This topic needn’t be covered by a fig leaf ? as there is so much that can be done! Why not make the life changing changes conservatively! This topic needs a change in direction so don’t turn it away. Please go to Amy’s website and give her a call or send her an e-mail and help yourself or someone you know. www.pelvicformphysiotherapy.com.au

Yes! High-quality evidence proves that exercise reduces pain and improves physical function in patients with osteoarthritis.

Osteoarthritis (OA) has a significant impact on one’s physical function and quality of life. The knee, hip and hand joints are predominantly involved, resulting in physical symptoms of pain, swelling and reduced function. Furthermore psychosocial symptoms of anxiety and depression can occur as a result of this condition.

Exercise has been shown to reduce pain and also demonstrate positive effects on physical function immediately after treatment, and sustained 3-6 months after treatment. Research has also shown that Physiotherapy manual mobilisation alongside exercise prescription has shown greater improvement in pain.

In summary your Physiotherapist can help your osteoarthritis through use of manual mobilisation to optimise pain relief, alongside a prescribed evidence based exercise program to target the affected joint(s).

Written by: Nicole Pereira

References

Walsh, N. E., Pearson, J., & Healey, E. L. (2017). Physiotherapy management of lower limb osteoarthritis. British Medical Bulletin, 122(1), 151-161. doi:10.1093/bmb/ldx012

Bennell, K. (2013). Physiotherapy management of hip osteoarthritis. Journal of Physiotherapy, 59(3), 145-157. doi:10.1016/s1836-9553(13)70179-6

Jansen, M. J., Viechtbauer, W., Lenssen, A. F., Hendriks, E. J., & De Bie, R. A. (2011). Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. Journal of Physiotherapy, 57(1), 11-20. doi:10.1016/s1836-9553(11)70002-9

Beckwée, D., Vaes, P., Cnudde, M., Swinnen, E., & Bautmans, I. (2013). Osteoarthritis of the knee: Why does exercise work? A qualitative study of the literature. Ageing Research Reviews, 12(1), 226-236. doi:10.1016/j.arr.2012.09.005

Lumbar disc herniation is a common low back disorder that produces low back pain and/or leg pain in adults. A herniated disc is a displacement of disc material beyond the intervertebral disc space, these usually remain asymptomatic however can cause discomfort if the disc compresses an adjacent nerve or the spinal cord. Disc herniation often occurs as a result of age-related degeneration of the outer fibrous portion of the disc (annulus fibrosis), however trauma, straining, torsion and lifting injury are also involved.

Often we get asked – I have a herniated disc, do I need surgery to fix it?

Not Necessarily! Physiotherapy often plays a major role in disc recovery. Infact, research shows no statistically significant differences between conservative management and surgical management of disc herniation after 1 and 2 years. Physiotherapy does not only offer pain relief and decrease disability, but it also contributes to protecting the body to prevent further injury.

Research shows that large disc herniations decrease in size proportionally more than smaller protrusions and therefore that the greater the herniation the greater the resorption.

In some instances however, surgical intervention may be required. Your Physiotherapist will determine your prognosis on examination, and take appropriate action.

Written by: Nicole Pereira

References:

Chui, CC, Chuang, T., Chang, K.H., Wu, C.H., Lin, P.W, & Hsu, W.Y. (2015). The probability of spontaneous regression of lumbar herniated disc: a systematic review. Clinical Rehabilitation 29 (2): 184-195.

Gugliotta, M., Da Costa, B. R., Dabis, E., Theiler, R., Jüni, P., Reichenbach, S., … Hasler, P. (2016). Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open, 6(12), e012938. doi:10.1136/bmjopen-2016-012938

Jacobs, W. C., Van Tulder, M., Arts, M., Rubinstein, S. M., Van Middelkoop, M., Ostelo, R., … Peul, W. C. (2010). Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review. European Spine Journal, 20(4), 513-522. doi:10.1007/s00586-010-1603-7

Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs Nonoperative Treatment for Lumbar Disk HerniationThe Spine Patient Outcomes Research Trial (SPORT): A Randomized Trial. JAMA. 2006;296(20):2441–2450. doi:10.1001/jama.296.20.2441

A recent systematic review has evaluated the effect of sleep deprivation (i.e. no sleep) and sleep restriction (i.e. a reduced sleep duration) on resistance exercise performance. Resistance exercise is an effective means to maintain and improve physical capacity and metabolic health, however, the outcomes for populations who may perform resistance exercise during periods of inadequate sleep are unknown. Inadequate sleep (e.g., an insufficient duration of sleep per night) can reduce physical performance and has been linked to adverse metabolic health outcomes.

The outcomes show that inadequate sleep impairs maximal muscle strength in compound movements when performed without specific interventions designed to increase motivation. Strategies to assist groups facing inadequate sleep to effectively perform resistance training may include supplementing their motivation by training in groups or ingesting caffeine; or training prior to prolonged periods of wakefulness.

Read the full paper here:

Inadequate sleep and muscle strength- Implications for resistance training

Anterior cruciate ligament (ACL) injury is one of the most commonly seen injuries in sport and has a devastating influence on patients activity levels and quality of life.

Complete ACL rupture can induce other pathological knee conditions including knee instability, damage to menisci and the chondral surface. This can lead to early onset of osteoarthritis.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments. Female athletes had a higher incidence of ACL injuries compared with their male counterparts. Studies have shown that the incidence in female athletes is two to eight times higher than in males in soccer, basketball and volleyball.

Anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It provides approximately 85% of total restraining force to prevent the shin bone from sliding out in front of the thigh bone, as well as provides rotational stability to the knee. To a lesser degree, the ACL checks extension and hyperextension 

Mechanism of Injury

ACL tears typically occur during activities placing excessive strain on the ACL. This generally occurs suddenly due to a specific incident, however, occasionally may occur due to repetitive strain. Movements that place stress on the ACL include:

• twisting of the knee
• hyperextension of the knee
• sudden deceleration when running
• poor landing from a jump
• collision forcing the knee to bend in the wrong direction

More than three quarters of ACL injuries have been reported to occur in noncontact situations (no direct contact to the knee when knee is injured), mostly while performing sports. A person typically reports feeling a popping sensation in the knee, as well as a rapid onset of considerable swelling (within the first few hours following injury).

Written By: Nicole Pereira

References

Dordevic, M., & Hirschmann, M. T. (2014). Injury Mechanisms of ACL Tear. Anterior Cruciate Ligament Reconstruction, 49-53. doi:10.1007/978-3-642-45349-6_7

Yu, B., & Garrett, W. E. (2007). Mechanisms of non-contact ACL injuries. British Journal of Sports Medicine, 41(Supplement 1), i47-i51. doi:10.1136/bjsm.2007.037192

Paterno, M. V., Rauh, M. J., Schmitt, L. C., Ford, K. R., & Hewett, T. E. (2014). Incidence of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport. The American Journal of Sports Medicine, 42(7), 1567-1573. doi:10.1177/0363546514530088

Hewett, T. E., Myer, G. D., Ford, K. R., Paterno, M. V., & Quatman, C. E. (2016). Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. Journal of Orthopaedic Research, 34(11), 1843-1855. doi:10.1002/jor.23414

It’s a question we are asked a lot, “would a sit-stand desk be good for me?”. This blog presents a choice for you, a summary of the most recent literature on the topic (STSSummary) and a more detailed literature review on the topic STSLitRev for those more interested in the detail. I hope you enjoy the reading, a lot of work went into reading and then writing them!

The basis of the word placebo comes from, in Latin, ‘it will please’. Therefore placebo is generally conceptualized as something which is done to someone rather than giving them ‘real’ treatment, per se. The response seen in the patient has nothing to do with what is in the treatment per se but it is the simulation of therapy that drives changes in the person’s brain and body. Therefore when we study the placebo effect we are studying the effect of the psychosocial context around the person and how this context affects their mind, brain and body.

There is also more than one placebo effect. From a biological viewpoint we know that certain placebo’s are mediated by our internal opioid system, or endogenous opiates, and others by chemicals (such as dopamine) and systems (motor, cardiovascular, respiratory and endocrine systems). From the psychological viewpoint, there are many instances where the expectation of benefit increases placebo effects. But there are also instances when conditioning or learning mechanisms are at play – background experience, social observation, differences in culture, etc.

Learn more from our previous blogs on this topic by clicking the links below. Some interesting reading and watching indeed!

Paracetamol – Placebo

The Placebo Effect

Anti-inflammatories and Back Pain

A new guideline released by the RACGP today addresses the growing community concern over opioid misuse and addiction. A key recommendation is that GPs refer patients to physios early for acute musculoskeletal pain.

Prescribing drugs of dependence in general practice – part C recognises that drugs of dependence (ie opioids) have important therapeutic uses, but that prescription of these medicines must always be clinically appropriate and supported by national and state laws.

One of its recommendations to GPs is to engage a physio early in more severe acute musculoskeletal injuries, as well as look at multidisciplinary care options for their patients suffering chronic pain.

APA member Lorimer Moseley, who is Professor of Clinical Neurosciences and Chair in Physiotherapy at the University of South Australia, was involved in the review process for the new RACGP guideline. Professor Moseley is at the forefront of chronic and complex pain treatment approaches internationally. He said, “That physiotherapists are critical in delivering evidence-based care is accepted and not surprising; modern physiotherapists are field leaders in their understanding of contemporary pain science. They have an ideal skill set to facilitate recovery and to prevent chronic pain.”

APA National President Phil Calvert welcomed the new guideline, but also went a step further. “Our members work with patients who suffer acute pain on a daily basis, so we know that early and regular physio treatment leads to beneficial outcomes for them. But to really address the issue of reducing opioid prescriptions, patient referrals to physios needs to be supported by a government funding mechanism.”

“This will allow patients to be active participants in their recovery from injury and chronic pain. Short term medicine prescription may be a part of this, but it doesn’t have to be the only solution. Physio is a highly viable, evidence based treatment for acute and chronic pain conditions, and is also less costly to the health system – and the economy as a whole – when compared to long term opioid use and the complex personal and social issues that go with this.”

Source: APA News Media Release 27th October 2017

“Ooh but it won’t happen to me”…..Is that what you thought when you looked at this photo?…… A common thought these days when we hear about cause and effect when it relates to yourself is to think exactly that. What is it that makes you think that way? Is it the fact that you’re only young and that is so far away? Is it shear stubbornness or neglect of the natural progression from where you currently are? Or is it the comfort of knowing that you hold yourself well and are doing as much as you can to prevent that happening?

So the real question then becomes, what are YOU doing to support the thought “ooh but it wont happen to me”? That’s where the cause can be altered to create a different effect.

Research abounds with information regarding the change in our body tissues over the course of time. Many of these changes occur from quite early in our life and slowly change, whilst others seemingly occur overnight (how many of you almost overnight noticed a change in your vision, perhaps with some initial neglect, and now can see the light again once you were prescribed glasses). Whilst we cannot altogether stop the natural age related change within our tissue, we can in many cases, slow the progression or deterioration of this tissue with age. A great example of this is the effect that resistance training (strength) can have upon muscle tissue and the bodies metabolic processes to save off insulin resistance changes and diseases like diabetes, for cardiovascular and respiratory benefits and of course falls prevention.

So how does the way we move affect our body and it’s tissue? The answer is it can have a positive influence (as for the example above) or a negative influence (for example how bending or sitting poorly can effect the loading on the lower back). The below Figures (McGill, 1997) show how the repetitive effects of small loads (top Figure) or the sustained effect of a small load (bottom figure) can result in tissue fatigue, reducing the failure tolerance and leading to failure. This can also increase the risk of a single event (a single higher load) causing a tissue failure (eg. a fall to the ground resulting in a fracture from a seemingly quite low force). Part of good musculoskeletal health is having the ability to resist force and create force without causing tissue failure. A key feature is the positioning of our body in space in such a way that the joints, muscles and other tissue can create their desired effect with minimal energy production or force absorption thereby reducing their risk of injury. Therefore, if your thought was “it wont happen to me” then make a change now because without perfect mechanics the effect of gravity is such that the cumulative effect can result in this change occurring slowly and then before you know it it’s either a lot harder to change or it can’t be changed.

The opening picture depicts how slouching, sitting poorly/too long, failing to stand tall when younger can effect the body in such a way that by the time your older it’s impossible to stand up straight. It may not happen overnight but it does happen!

I have the picture of a teenager sitting in front of me slouching all day at school/studying at home, standing slouched and thinking “it won’t happen to me”. My advice is let’s try and keep what you have before it breaks as opposed to trying to fix it once it is broken. That young flexible spine with repetitive or prolonged loading in this way is subjected to altered loading and becomes stiff to straighten. The soft-tissue at the front of the body shortens and ties the body down making it harder to straighten up whilst the tissue at the back is lengthened and working hard just to counter gravity and try to keep some resemblance of upright so we can see where we are going. This tissue gets tired and cranky as it’s not designed to work in this way, whilst our stabilising muscles become weak (we haven’t been using them to hold us up but rather relying on ‘hanging’ off our joints to do so).

Before long we are in our 30’s and 40’s going through “beautiful chaos” and we start noticing, most of the time, pain somewhere. Professional help is sought and guess what, you find that your spine’s not as mobile as it once was, you’re a bit weaker in places you should be stronger and your tight in areas you once had good flexibility. The bad news is it takes longer to correct than when you were a teenager and might not be fully reversible requiring personal diligence to stay where you are and not regress further. The good news is that what you need to do now is easier than what you might need to do in another 20-30 years if you hadn’t attended to it. Seek assistance now if this is you!

Then without attention you reach the stage of the gentleman pictured. You can’t stand up straight, your neck hurts because it’s having to look up all the time just for you to see where you are going, you can’t reach as high, you have arthritis throughout your body, your not as balanced on your feet (may be complicated by diabetes or vascular effects reducing sensation in the feet) and need an aide to prevent falling. It doesn’t happen overnight but it does happen! To combat this I get clients of mine to stretch their chest through a doorway and then lie on a rolled towel across their upper back to open their chest and extend the spine. Similarly when sitting it’s not only important to break it up regularly by moving (see ‘Sitting is the New Smoking’) but also to make sure you sit well. This can be done by sitting to maintain a slight curve in the small of your back with your knees higher than your hips, pelvis tilted forward, chest lifted and head over your shoulders lengthening towards the ceiling. 

Make the change now and seek the advice and correction of a trusted physiotherapy professional to set you in the right direction. A small investment in time now will have much longer lasting effects for your entire life to help you “live your whole life better”. The truth is too, the sooner and younger the start, the easier any change is and the more you can do that will make a difference. That’s important, seek professional advice but remember the professional is there to help you but ultimately you are the main player! 99% of the time you are out living your life (not with the professional having treatment) and so the professional needs to educate you and arm you with tools (eg. Exercises) to help you maintain and improve you in their absence. Without active engagement, passive treatment is never going to achieve the results that could be achieved. So if you are motivated but feel that your care is purely reliant on what the practitioner does with you (ie. you haven’t been given any tools to help yourself as well) then I would recommend you seek a trusted professional with a more wholistic view of your health.

Written by: Scott Ward

Disclaimer: These are general comments and do not take into account your specific health condition. It is extremely important to get advice before undertaking any new exercises but one thing is sure though, it is very important to have a professional who can help you plan ahead. You can contact our team on the following details to arrange a meeting to look at your current circumstances.

It’s partly true!……..but it’s not all about sitting. It’s more about how a sedentary lifestyle, including sitting, is perhaps the new smoking. However, unlike smoking which has no health benefits to anyone and I would be happy to eradicate, sitting is something that we don’t want to eradicate and is in fact something that we should have some of, in some capacity. Just not too much!

We know that prolonged sitting is not good for our health, because people have picked up this new message (‘sitting is killing you’) and sales of standing desks have rocketed. Anecdotally however, there are people who also have musculoskeletal problems from standing all day. In short people hear the message that sitting is bad so they stand for long periods instead. It’s important to note prolonged standing can also have adverse health effects. Compared to sitting, when we stand, our hearts and circulatory systems work harder to maintain blood flow to the brain, because they are countering the effects of gravity. Standing still for long periods of time can lead to swelling, heaviness or cramping of the legs. Enforced standing has actually been used as an interrogation technique. That is why sitting is still a part of what we need to do each day but just not in the volume that we do it!

The following is a combination of journal research, blogs, press articles and my thoughts on this topic. I hope you enjoy the read and it creates a call to action for yourself if it’s relevant.

Scary Facts

• Physical inactivity contributes to over three million preventable deaths worldwide each year (that’s 6 per cent of all deaths). It is the fourth leading cause of death due to non-communicable diseases.
• It is also the cause of 21–25 per cent of breast and colon cancers, 27 per cent of diabetes cases, and around 30 per cent of ischaemic heart disease. In fact, physical inactivity is the second highest cause of cancer in Australia, behind tobacco smoking.
• The researchers linked four or more hours a day of television watching with an 80 per cent increased risk of death from heart disease, and a 46 per cent increased risk of death from all causes. That’s compared to people who spent less than two hours a day in front of the box.

So let’s have a look at general activity levels within Australia.

According to ‘Australia’s Health In Brief report 2016’ in 2014–15, almost half (45%) of adults aged 18–64 were inactive or insufficiently active for health benefits, which was similar to the proportion in 2011–12.

In 2009 the “Stand Up Australia” report found:

• 77% of office-based, call centre and retail employee behaviours during their working day was spent sitting (equated to 70% of the day on work days).
• Individuals who spend high amounts of time sitting at work also tend to spend high amounts of time sitting on non-work days. (equated to 62% of the day on non-work days).
• Participants in the study perceived they had much higher levels of physical activity than they did when measured objectively (accelerometers).
• Only 5% of the time on work and non-work days was performing moderate-to-vigorous intensity physical exercise (recommended in the current National Physical Activity Guidelines) with the remainder occupied with light-intensity (incidental) physical activity.
• Significantly more time was spent in light-intensity activity on non-work days compared with work days.
• Interestingly, more moderate-to-vigorous intensity activity occurred on work days compared with non-work days.

If you live a sedentary lifestyle, you have a higher chance of developing:

• Obesity
• Type 2 diabetes
• Heart disease
• Depression and anxiety.

Therefore, living a sedentary lifestyle can be dangerous to your health!

Many people know when they’ve been sitting too long because their back or neck gets sore. These are effects many can relate to because we can actually feel them. But it’s what you can’t feel or see that you may need to be concerned about. Canadian researcher Dr Peter Katzmarzyk, for instance, found that those who sat almost all of the time had nearly a one-third higher risk of early death than those who stood almost all of the time.

University College London researcher Dr Emmanuel Stamatakis found similar results among women in the United Kingdom: those whose work involved mostly standing/walking about had a 32% lower risk of early death than those who worked in sitting jobs.

 How does a sedentary lifestyle affect your body?

Humans are built to stand upright. Our heart and cardiovascular system work more effectively this way. Therefore when sitting for long periods of time the following can happen:

Legs and gluteals (bum muscles)

Sitting for long periods can lead to atrophy of large leg and gluteal muscles, where they weaken and waste away. If you don’t use them, you lose them! These large muscles are important for walking and for stabilising you. If these muscles are weak you are more likely to injure yourself from falls, and from strains when you do exercise.

One study reported 2.5 times higher average muscular activity of the thigh when standing compared to sitting. This is important for improving blood sugar profiles and vascular health, reducing the risk of early death.

Weight

Moving your muscles helps your body digest the fats and sugars you eat. If you spend a lot of time sitting, digestion is not as efficient, so you retain those fats and sugars as fat in your body.

The latest research suggests you need 60–75 minutes per day of moderate-intensity activity to combat the dangers of excessive sitting.

Hips and back

Just like your legs and gluteals, your hips and back will not support you as well if you sit for long periods. Sitting causes your hip flexor muscles to shorten, which can lead to problems with your hip joints.

Sitting for long periods can also cause problems with your back, especially if you consistently sit with poor posture or don’t use an ergonomically designed chair or workstation. Poor posture may also cause poor spine health such as compression in the discs in your spine, leading to premature degeneration, which can be very painful.

Anxiety and depression

We don’t understand the links between sitting and mental health as well as we do the links between sitting and physical health yet, but we do know that the risk of both anxiety and depression is higher in people that sit more.

This might be because people who spend a lot of time sitting are missing the positive effects of physical activity and fitness. If so, getting up and moving may help.

Cancer

Emerging studies suggest the dangers of sitting include increasing your chances of developing some types of cancer, including lung, uterine, and colon cancers. The reason behind this is not yet known.

Diabetes

Studies have shown that even five days lying in bed can lead to increased insulin resistance in your body (this will cause your blood sugars to increase above what is healthy). Research suggests that people who spend more time sitting have a 112 per cent higher risk of diabetes.

Varicose veins

Sitting for long periods can lead to varicose veins or spider veins (a smaller version of varicose veins). This is because sitting causes blood to pool in your legs. This is why you here of people getting DVT’s with flying, fluid flows better through a straight pipe than one with a ‘kink’ in it.

Deep vein thrombosis

Sitting for too long can cause deep vein thrombosis (DVT). A deep vein thrombosis is a blood clot that forms in the veins of your leg.

DVT is a serious problem, because if part of a blood clot in the leg vein breaks off and travels, it can cut off the blood flow to other parts of the body, this is a medical emergency that can lead to major complications or even death.

Stiff neck and shoulders

If you spend your time hunched over a computer screen, this can lead to pain and stiffness in your neck and shoulders.

Epidemiological studies show that neck pain is:

• greatest in females
• peaks in the 40’s (although age is not a risk factor, it is a prognostic factor)
• unmodifiable risk factors are;
  • female
  • previous neck pain
  • number of children
  • previous LBP
  • self-assessed poor health (?modifiable)
  • poor psychological health (?modifiable)
• risk factors for office workers are:
  • low workplace satisfaction
  • keyboard close to the body
  • low work variation
  • self perceived muscular tension
• not risk factors for office workers:
  • frequency of physical activity during leisure
• preventative (risk and prognostic factors) in office workers:
  • greater cervical ROM
  • greater Cx extensor endurance
  • a program of cervical strengthening exercises

How can you save your health from the dangers of sitting?

If you’re not getting enough activity in your day, it’s not too late to turn it around and gain great health benefits in the process.

To obtain the health benefits of standing and reduce the potential adverse effects, the best option is to alternate between sitting and standing. Our message is to stand up, sit less and move more.

Alternating between sitting and standing will increase muscular contractions, stimulating blood flow and resulting in more calories burnt and healthier blood sugar levels. Recent findings from a lab show that alternating between 30 minutes of sitting and standing can improve blood sugar levels after a meal.

The point is that our physical activity guidelines promote breaking up sitting time. We can debate whether standing is better for you than standing but what is most important is that people need to move more. Remaining in one posture for long periods is not good for muscles that are not trained to do that. The other important thing is no matter what you do, there is a difference in doing the right way versus doing it the wrong way and often what we see are the effects of doing it the wrong way.

??Purchase a standing desk??

Now, if you’re leaning towards getting a standing desk but are concerned about your concentration and productivity, there’s some good news. Research shows task performance such as typing, reading and performing cognitive tests is largely unaffected by standing desks. A study by Commissaris et al., (2010) measured both objective and perceived work performance during the performance of five standardised but common office tasks in an office-like laboratory setting. With the exception of high precision mouse tasks, short term work performance was not affected by working on a dynamic or a standing workstation. The participant’s perception of decreased performance might complicate the acceptance of dynamic workstations, although most participants indicate that they would use a dynamic workstation if available at the workplace.

Build more activity into your day

The key is to avoid sitting as much as possible or at least break up your sitting time – even if only by standing, which uses more muscles than sitting. Research shows that people who break up their sedentary time throughout the day, regardless of their total sedentary time, have a better health profile.

Some ways you can incorporate activity into your day are:

• Walk or cycle, and leave the car at home.
• For longer trips, walk or cycle part of the way.
• Use the stairs instead of the lift or escalator, or at least walk up the escalator.
• Get off the bus one stop early and walk the rest of the way.
• Park further away from wherever you’re going and walk the rest of the way.
• Walk to the printer

Be active at work

 You can move around at work more than you think:

• Take the stairs instead of the lift.
• Walk over and talk to your colleagues instead of emailing them.
• Take your lunch break away from your desk and enjoy a short walk outside if you can.
• Organise walking or standing meetings.
• Stand up or walk while on the phone
• Stand up every 30 mins
• Try a simple exercise program at work

– forward raise, lateral raise (deltoid) – (use water bottle for weight) 10 X2

– shoulder shrugs 10 X 2

– resisted neck flexion, extension and lateral flexion – 5 sec holds 70-80% MVC

Reduce your sedentary behaviour

 Here are some simple ideas to keep moving while you’re at home:

• When you’re tidying up, put items away in small trips rather than taking it all together.
• Set the timer on your television to turn off an hour earlier than usual to remind you to get up and move.
• Walk around when you are on the phone.
• Stand up and do some ironing during your favourite television shows.
• Rather than sitting down to read, listen to recorded books while you walk, clean, or work in the garden.
• Stand on public transport, or get off one stop early and walk to your destination.

And if you work in an office:

• Stand up while you read emails or reports.
• Move your rubbish bin away from your desk so you have to get up to throw anything away.
• Use the speaker phone for conference calls and walk around the room during the calls.

Remember…

Moving around is good for you. It’s good for your physical health as well as your mental health.

Sitting or lying for too long increases your risk of chronic health problems, such as heart disease, diabetes and some cancers.

Being active is not as hard as you think. There are lots of simple ways to include some physical activity in your day.

Consult us at Nelson Bay Physiotherapy & Sports Injury Centre to receive personalised recommendations around your best sitting position, chair set-up, workstation, driving position, computer, keyboard or even standing work-station set-up. We have a range of products to demonstrate and recommend to you to help make your day easier. 

Written by: Scott Ward

References:

Andersen L.L., Christensen K. B.,  Holtermann A., Poulsen O.M., Sjøgaard G., c , Pedersen M. T., & Hansen E.A. (2010). Effect of physical exercise interventions on musculoskeletal pain in all body regions among office workers: A one-year randomized controlled trial. Manual Therapy 15 (2010) 100–104.

Australian Government: Australian Institute of Health & Welfare. Australia’s Health In Brief (2016). https://www.nelsonbayphysiotherapy.com.au/wp-content/uploads/2015/05/Australias-Health-In-Brief-2016.pdf

Commissaris D. A. C. M., Konemann R., Hiemstra-van Mastrigt S., Burford E., Botter J., Douwes M., & Ellegast R. P. (2014). Effects of a standing and three dynamic workstations on computer task performance and cognitive function tests. Applied Ergonomics 45 (2014) 1570e1578

Medibank Private. Stand-up Australia: Sedentary Behaviour in Workers, August 2009. https://www.nelsonbayphysiotherapy.com.au/wp-content/uploads/2015/05/Stand-Up-Australia.pdf

The Sydney Morning Herald http://www.smh.com.au/technology/sci-tech/health-check-sitting-versus-standing-20140818-105jfq.html

Victoria State Government Better Health Channel https://www.betterhealth.vic.gov.au/health/healthyliving/the-dangers-of-sitting

Greater Trochanteric Pain Syndrome (GTPS) refers to pain originating from various structures in the lateral hip; mainly tendons and muscle tears. Traditionally lateral hip pain has been diagnosed as ‘Trochanteric Bursitis’, but imaging, histological and surgery studies have challenged this diagnosis by disproving the presence of any inflammation in this condition.

Lateral hip pain is termed GTPS as an umbrella term as several muscles insert on or near the greater trochanter (hip bone) that could be the cause of pain (gluteus maximus, gluteus medius, gluteus minimus, piriformis, tensor fascia late, iliotibial band, obturator externus, and obturator internus).

Who is affected?

Lateral hip pain affects 10% to 25% of the general population. GTPS most frequently occurs in late middle-aged women.

Presentation

Patients with GTPS will present with lateral hip pain, which is aggravated with pressure on that side of the body, such as while lying down. They often complain of pain with walking, stairs and may admit that pain is worse while standing on the affected leg. There may be associated pain radiation down the outside thigh but rarely below the knee.

How is it caused?

The cause of greater trochanteric pain syndrome is not completely understood, although rheumatologists and orthopeadic surgeons are becoming increasingly aware that local microtrauma leading to tears of the abductor (Gluteus minimimus/ maximus) tendons may be a leading cause of this syndrome.

It is hypothesised that excessive hip adduction (crossing over of legs) during functional activities may compress the gluteus medius and minimus tendons against the greater trochanter (hip bone) causing damage. Examples include standing with one hip in adduction (hanging on one hip), sitting with knees together or crossed over, and poor pelvic stability in dynamic single leg loading tasks. Running with a midline or cross-midline foot-ground contact pattern, on the camber of a road or in the same direction around a track are examples of dynamic activities that also adduct the hip, and could increase risk for development of lateral hip pain.

Additionally, the increased prevalence of GTPS in post-menopausal women suggests that deficits in female sex hormone may be implicated in the condition.

Treatment

Research shows that an exercise program targeting gluteal strength and correction to the kinetic chain is superior to cortisone injection, shockwave therapy and rest alone.

Here at Nelson Bay Physiotherapy we perform comprehensive clinical examinations to correctly diagnose and treat GTPS. From these assessments, we are able to provide tailored exercise programs, manual therapy, electrotherapy and taping to correct kinetic chain dysfunction and gluteal weakness. We ensure an appropriate and progressive loading program to ensure the tendon not only recovers, but the pain does not come back again. We work with your lifestyle and movement patterns to ensure that you’re not aggravating your tendons on a day to day basis, and modify your activities as needed.

Lastly

Hip pain is a major impediment to good health, capacity for physical activity, quality of life and mental health. Activity limitation because of hip pain is especially disturbing in older women (most commonly affected) due to known issues of loss of bone and muscle strength associated with menopause and increasing age.

Don’t put up with your uncomfortable hip – come and see us today to live your whole life better.

Written By: Nicole Pereira

References:

Allison, K., Vicenzino, B., Wrigley, T.V., Grimaldi, A., Hodges P.W. & Bennell, K.L. (2016). Hip Abductor Muscle Weakness in Individuals with Gluteal Tendinopathy. Medicine & Science in Sports & Exercise, 48(3), 346-352. doi:10.1249/mss.000000000000078

Fearon, A. M., Cook, J. L., Scarvell, J. M., Neeman, T., Cormick, W., & Smith, P. N. (2014). Greater Trochanteric Pain Syndrome Negatively Affects Work, Physical Activity and Quality of Life: A Case Control Study. The Journal of Arthroplasty, 29(2), 383-386. doi:10.1016/j.arth.2012.10.016

Fearon, A. M., Scarvell, J. M., Neeman, T., Cook, J. L., Cormick, W., & Smith, P. N. (2012). Greater trochanteric pain syndrome: defining the clinical syndrome. British Journal of Sports Medicine, 47(10), 649-653. doi:10.1136/bjsports-2012-091565

Grimaldi, A., Mellor, R., Hodges, P., Bennell, K., Wajswelner, H., & Vicenzino, B. (2015). Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports Medicine, 45(8), 1107-1119. doi:10.1007/s40279-015-0336-5

SafeWork NSW has just released a new video about the dangers of being sedentary at work and ways people can move more and sit less.

On average, Australian adults spend an estimated five hours a day being sedentary, which can lead to health effects including lung stress, reduced blood flow, poor mental health and even some cancers. The good news is there are some easy ways to get moving at work.

The release of the video coincides with SafeWork NSW’s commitment to move more and sit less and to encourage workers to be less sedentary at work. Standing, walk-and-talk meetings or face-to-face exchange rather than email and sit-stand workstations are just some of the ways we’re ‘losing the chair!’ Make your own pledge and watch the video now.

Source: APA News 5^th July 2017

An interesting piece of commentary from a general practitioner following evidence-based care. The best place to go for knowledgable professional diagnosis and treatment is here with one of our physiotherapists. Have a read by clicking here, the article reflects the truth and emphasises again that Imaging is often an expensive waste-of-time. Spend your money wisely and see us. If we think something extraordinary is occurring then you will be referred to the appropriate place.

Pregnancy often causes marked lower back and pelvic pain as a consequence of the extra weight carried, the changes in the spinal curvature and the presence of pregnancy hormones that increase joint laxity. Once the baby comes along you’d be excused if you thought “phew, glad that’s over now my pain can go”.

However, many women have found that whilst their lower back pain can settle after childbirth, many Mums (and Dad’s) report the presence of neck, shoulder and thoracic spine pain as a consequence of caring for their child.

So what can you do about it? Here’s some tips to help Mums and Dad’s in that situation…..click here to find out more.

It’s the symptom that motivates people to seek professional help, it’s often the last symptom to present to make you aware of a problem and sometimes it can be the first to disappear. For some however it can be a much greater and longer lasting symptom. Recently, there was an interesting piece on the ABC’s Catalyst regarding pain and advancements in medical engineering to help bring relief to many of these people.

Similarly Radio National had a great piece on explaining pain and how it works. Click the link to read more and hear Lynne Malcolm reports on the latest developments in chronic pain research.

At Nelson Bay Physiotherapy & Sports Injury Centre, we also offer the Pain Book for sale to anyone wishing to learn more about their pain and how to better manage it.

So what is a Placebo? Could a placebo be effective? How? Is it ethical?

Explore this excellent SBS Insight topic here. Well worth a watch. It certainly raises some interesting questions regarding consent and ethics and once again displays the awesome power of our brain and nervous system.

What are they? Click on this link to find out what the 5 things sports physios wish you knew are. You may already know them!

26th May 2015

Are you spending hours slouching over a computer, and feeling the strain in your muscles? With all the time we spend staring at our screens, it’s important we don’t turn a blind eye to the importance of how our work space is set up.

Incorrect posture at your desk can lead to many problems including neck pain, back pain and headaches, so it is vitally important the area where you spend a lot of time each day, is set up correctly.

To assist, Australian Physiotherapy Association (APA) National President Marcus Dripps has provided his top tips and tricks:


1. Place your screen at eye level

Dripps recommends positioning your screen so it is directly in front of you, about an arm’s length away, with the top of the screen at eye level. “This ensures your head is in line with your torso so your neck and shoulder muscles are less fatigued. If you’re using a laptop, it might be best to get a stand for your monitor,” he says.

2. Support your back

“This is key. Adjusting your chair so your lower back is supported will reduce strain on your back. Ensure your knees are level with your hips too–this will help to relax your shoulder and neck muscles.”


3. Check placement of your elbows, arms and wrists

According to Dripps, placing your keyboard in a position where you can reach it comfortably and at a height where your wrists and forearms are straight and level with the floor is imperative. “Your elbows should be by the side of your body so the arm forms an L-shape at the elbow joint. This will help prevent repetitive strain injuries,” he says.

4. Refine your keyboard location

“Be sure your keyboard is directly in front of you when typing, leaving a gap of about 100–150mm at the front of the desk to rest your wrists between tasks. Keep in mind, your wrists should be straight when using a keyboard.”


5. Keep your mouse close

Dripps says a simple tip is to keep your mouse and the keyboard close to you–this will help avoid strain and support your arm on the desk when using the mouse. “A mouse mat with a wrist pad can also help keep your wrist straight and avoid awkward bending.”


6. Rest your feet on the floor

Both of your feet should be comfortable, either flat on the floor or supported by a footrest. He strongly recommends not crossing your legs as it could result in bad posture with resultant harmful effects’ on the back, hip and pelvis.


7.Take a break

“Finally and importantly, take regular breaks every hour to stretch your legs, drink plenty of water and remember to regularly do some simple neck and back stretches,” Dripps concludes.

About the Australian Physiotherapy Association (APA)

The APA is the peak body representing the interests of Australian physiotherapists and their patients. It is a national organisation with state and territory branches and specialty subgroups. The APA represents more than 17,000 members who conduct more than 21 million consultations each year.

Yoga is one of those activities that can be difficult to get a handle on. There’s a lot of different types, it means different things to different people, and there are a lot of unique preferences. So is yoga actually good for you?

Breaking down yoga styles might take a while. Bikram is ‘hot’ yoga, where the temperature of the room is purposefully higher. Power yoga is more about strength, while classes like Ashtanga are focused on athletics. There’s a range of others – often marketing or westernising the traditional practice that originated from India.

While there are different types, the general premise of yoga is building strength, flexibility, and balance, as well as mental and spiritual practices.

We’ll take a look at how yoga can help in those areas (and what might be a little bit of an exaggeration).

What yoga can do for your body

Good for: Strength, balance and flexibility

Yoga can work to build strength in some poses, especially if your current level of fitness is low. If you’re starting from nothing, it will be a challenge. Yoga’s progress involved holding a pose with better form, or for longer, or doing a more advanced version. Yoga via Youtube can take you some of the way, but it’s likely you’ll hit a limit..

It can be hard to progress without an instructor. And that’s where the line is blurred between a ‘practitioner’ who happens to have found themselves teaching yoga, and someone more like a physiotherapist, who has studied and trained for years at university to understand the human body.

It’s worth looking into whom your potential instructor might be.

Yoga is decidedly good for muscle flexibility and joint range of motion, with most styles focusing on stretching and flexibility training. This reduces your chances of injury; the next time you need to leap over something, you won’t be in danger of tearing a hamstring from the sudden effort. It’s also much easier to put socks on in the morning.

Another benefit mentioned by Vitals is that yoga helps with neuromuscular training. In particular, studies have shown that ACL knee injuries can be reduced by deliberately training the connection and coordination between your brain and your muscles.

Yoga is one way to do this – there’s also more rigid training techniques such as the PEP programme developed by Santa Monica Orthopaedics and Sports Medicine Research Foundation. It’s sort of a side-benefit.

What yoga can’t do for your body

Not good for: Cardio, weight-loss, ‘toxins’.

Your cardio might improve slightly, but you won’t see the marked improvement that running, cycling, swimming or aerobic training would offer. You suffer in certain yoga poses and you know you’ve worked out, but you don’t breathe as hard or get your heart rate up as high as you do when embarking on a tough run or a couple of laps of some hills on two wheels.

Techly spoke with Australian Physiotherapy Association sports physiotherapist Holly Brasher, who holds a Bachelor of Applied Science (Physiotherapy), a Masters in Sports Physio, and is Managing Director of SquareOne Physiotherapy, to discuss more.

She agreed with the summaries and confirmed that yoga isn’t the ‘ideal choice’ for weight-loss, given other activities will burn more calories faster – such as running.

As for removing toxins and the like these are a complete myth. Your body has a liver, which is precisely made for removing toxins.

Beliefs around chakras and reiki and ‘vital energy’ of ‘qi’ and others haven’t been proven in any peer-reviewed science experiment – but they’re more related to spirituality, and not directly related to the physical qualities of yoga discussed here.

What’s the harm with yoga?

To get to the bottom of if yoga isn’t suitable for some people, we asked Ms Brasher what she’d recommend for people considering yoga for their general fitness.

“Yoga is great for improving flexibility. If you are a person who’s flexibility is poor then regular yoga classes will help.

“Conversely, if you are a person who is hypermobile (very flexible) then yoga is not the best choice of exercise. By further increasing an already large range of motion you are putting your body at risk of injury, as often the case is that you will not have the strength to control so much movement.”

“That is, if you are really flexible you need to be really strong to reduce your risk of injury. If you are after a gentle form of exercise then something like Pilates would be more appropriate as it works more on strengthening the postural muscles.”

In terms of yoga resulting in injuries, there are some potential problems. Holly Brasher again:

“Unfortunately there are many problems with yoga as a form of exercise.

“The problem is that “gurus” claim who believe their form of exercise i.e yoga is going to “cure everything and everyone.

“Each person needs to be dealt with individually, so whilst I would recommend yoga to one person I would tell another to stay away based on their pathology.

“Back pain is often grouped into one solid lump when the causes of back pain are very varied and the treatment and management of them is also. Some conditions need to avoid bending forward (eg. acute disc injury) and some need to avoid leaning backwards (eg. spondylolithesis).

“A yoga teacher would not have this knowledge so you can see how easy it is for someone to do a yoga class that involves everyone doing the same thing in the class to make their back pain worse.

“Overall, we mainly see problems with neck, back, knee and shoulder pain that is stirred up by yoga.

“My advice would be, if you have an injury, get advice from a health professional as to what you can and can’t do, as the same recipe does not work for everyone.”

Techly http://www.techly.com.au/2015/07/03/is-yoga-actually-beneficial-for-you/

BACKGROUND:
The impact of active workstations has been studied in several settings, and several outcomes have been investigated. However, the effects on health, work performance, quality of life, etc., have never been systematically reviewed.

OBJECTIVE:
To evaluate the existing literature about active workstations and their possible positive health and work performance effects.

DATA SOURCES:
We searched the electronic databases PubMed and Web of Science (up until 28 February 2014). The search terms we used were ‘active workstation’, ‘standing workstation’, ‘standing desk’, ‘stand up workstation’, ‘stand up desk’, ‘walking desk’, ‘walking workstation’, ‘treadmill workstation’, ‘treadmill desk’, ‘cycling workstation’, ‘cycling desk’ and ‘bike desk’, in combination with ‘health’, ‘quality of life’, ‘cognition’, ‘computer task performance’, ‘absenteeism’, ‘productivity’, ‘academic achievement’, ‘cognitive decline’, and ‘independent living’. In addition, we searched the reference lists of relevant published articles.

STUDY SELECTION:
Randomized controlled trials, non-randomized controlled trials and non-randomized non-controlled trials investigating the introduction of active workstations in humans were included in this systematic review. Only original studies were included, and we did not accept studies combining the introduction of active workstations with other interventions. Outcomes concerning health, energy expenditure, cognition, quality of life and work performance were included.

RESULTS:
We included 32 studies, of which five were longitudinal studies in school-aged children, 10 were longitudinal studies in adults and 17 were non-longitudinal studies in adults. Sixteen studies investigated standing desks, 15 investigated walking desks, and one investigated a cycling workstation. The general findings were decreased sitting time, increased energy expenditure, a positive effect on several health markers, no detrimental effect on work performance, no acute effect on cognitive function and no straightforward findings concerning computer task performance.

CONCLUSION:
The implementation of active workstations might contribute to improving people’s health and physical activity levels. The effect of the use of these active workstations on cognition and applied work tasks, such as computer task performance, needs further investigation before conclusions can be drawn. Another aspect that needs further investigation is the implementation of the different active workstations in all age groups.

PMID: 24842828 [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][PubMed – in process][/fusion_builder_column][/fusion_builder_row][/fusion_builder_container]