Understanding Hamstring Strains

Understanding Hamstring Strains

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Let’s get clued up on hamstring strains; why you may have one, what you can do to help and how to prevent a future injury. The hamstrings are a group of three muscles; the biceps femoris, semimembranosus and semitendinosus. You can feel these muscles if you place your hands on your sitting bones where the muscles originate and slide your hands down the back of your legs. The main action of these muscles is to bend your knee, take your leg out behind you and to assist rotation of your knee, especially when performing accelerating and decelerating actions.

 

A strain/pull/tear is when the muscle fibres are overstretched. Injuries are frequently felt as a short sharp pain in the back of your thigh whilst exercising. A hamstring strain will typically happen when running just before your foot hits the ground. At this point, the hamstrings are working eccentrically to control the forward motion of the two lower leg bones, your tibia and fibula. Pain is often the most debilitating symptom affecting your ability to continue exercising and may cause a limp. Other symptoms include swelling, bruising, muscle spasm and reduced movement at your knee.

 

Strains can be categorised into 3 different grades. 1 being the mildest with a small number of fibres being torn to grade 3 being the most severe which can be a complete muscle rupture. The good news is muscles have a fantastic blood supply and should heal within 3-12 weeks depending on the degree of injury. However, the flexible skeletal muscle fibres, which your muscles are made up of, are replaced with much more inflexible tough scar tissue, which is where physio’s come in. Specific rehabilitation such as specialist stretching, strengthening, taping and soft tissue techniques can dramatically influence how muscle fibres are restructured reducing the amount of scar tissue speeding up the healing process helping you return to sport quicker. With any soft tissue injury, R.I.C.E (rest, ice, compression, elevation) should always be your first response.

 

A physio will be able to perform a thorough assessment and educate you on why you sustained a hamstring strain in the first place. Common factors that can predispose you to hamstring strains are not warming up or cooling down properly, tight hamstrings or hip flexors, weak hamstrings or gluteal (butt) muscles, training at a high intensity without adequate training or altered biomechanics.

 

Runners often have short, weak hamstrings, tight hamstrings will restrict the length of your strides when running meaning you have to work harder to cover the same distance as you would with adequately lengthened hamstrings. Chronically tight hamstrings can cause not only hamstring strains but can contribute to back pain, knee pain and leg length discrepancies. So even if you have never stretched before it may be a good time to start stretching!

So to prevent yourself pulling a hammy make sure you warm up and cool down properly including effective stretching of not just your hamstrings but hip flexors, quadriceps and calf muscles, do sport specific strength and conditioning and avoid sudden increases in intensity of exercise. On your next visit why not ask your physio and find out how healthy your hamstrings are.

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What a ski physio can personally tell you about pain and injury.

What a ski physio can personally tell you about pain and injury.

by Kate MacDermid.

On a bluebird Monday morning in late August just after the last big dump of this season in Australia, my colleague and I were heading up the Sponars T-bar at Thredbo chatting all things life and snow.

The conversation shifted to injuries, both of us saying how lucky we’d been over these years having managed to avoid the injury “snow-tax” that it seems most have to pay at some stage.

We stood at the top of our favourite gully just off the T, I remarked how good the upcoming run looked and headed off first (because who likes to wait right?).

Almost immediately into my first turn I felt my tips stop me dead in my tracks, hitting something under the snowpack which sent me double-ejecting over the top of my skis.
My left binding held on for a fraction of a second before releasing, putting all the force through my ankle and causing it to dislocate, with the bottom of my tibia bursting apart at the same time.

And just like that, I finally paid my “snow tax”!

Kate’s Snow Tax

Kate’s Snow Tax



Now approaching three months after my injury, I’m by far no means fully rehabilitated. However having experienced a few home truths as a patient first hand, I thought they would be worth sharing.

Yes it hurts now, but won’t forever

Pain is pretty amazing beast. It commands our attention, threatens our thought patterns and instils fear and doubt in the best of us.

Even with a post-graduate degree that involved a whole semester on pain science, I was still blown away at how many different types of pain my brain could interpret from my nervous system following my injury.

“Hot”, “sharp”, “achy” and “raw” were all words I used to describe to what I have been feeling over the past months.

If I wasn’t already before, I am now acutely aware how worrying this must be for anyone going through his or her own rehabilitation, but rest assure its normal.
It really reinforced the importance of a good sports physio for the length of your rehab journey (lucky I know a good one).

Two steps forward, one step back

As a physio student, my textbooks lead to believe that my patient’s recovery will follow a lovely linear progression of steady improvement based on the weeks and months of tissue healing models that they described.

But tissue healing is just one of the many parts of this very complex process occurring.
Your activity level, rest, sleep, state of mind and mood are all factors that have a part to play here.

I was so excited the first time I was able to ride an exercise bike for 30 mins a few weeks back, only to have my ankle completely seize up the next day and being nicknamed “Peg-leg Pete”.

Rehabilitation involves huge fluctuations in healing and pain, which invariably brings the emotional highs, lows and setbacks with it.

It’s all connected

Anyone who has been through a lengthy rehab process will remember its secondary effects on other parts of the body.

Muscle wasting, joint stiffness and soreness in adjacent tissues are well-understood consequences of injury.

But perhaps what is less well recognised is the impact of an injury on our brains ability to sense where we are in space, or its ability to react quickly.
These lesser known deficits can often slide under the radar in late stage recovery, and their impact on future injury risk and performance is well researched.

It is vital that you partake in a well-rounded rehab program that reflects the demands of your various athletic pursuits.

Happier days on the slopes.

Happier days on the slopes.



Get psyched

Another doozy to get your head around is getting back out on the hill once you’ve been given the all clear to do so.

By the time you are ready to hit the slopes again after a lengthy rehab, you’ve had months to mull over the “could have”, “would have” and “should haves” of your injury.

And so understandably this may instil some fear and doubt in us over something like this happening again.

It’s not going to come as a surprise when I say that the best antidote to this is excellent physical preparedness.

We want you to be as robust as possible, and in most cases, even stronger than before your injury in order for you to be really confident both physically and mentally to get out there again.

Not all heroes wear capes

I have encountered some pretty amazing people following my injury. Calm and collected patrollers, my orthopaedic surgeon, friends, family, colleagues and the kindness of strangers do not go unnoticed when you are injured.

The silver lining to this whole process for me is the realisation that I’m lucky enough to have these people around me – so here’s a quick moment to say a thank you to them all.

Medial Ankle Pain

Medial Ankle Pain

Tibialis Posterior Tendinopathy


The tibialis posterior muscle sits just inside the shin, halfway up the lower leg. The muscle travels downwards and runs along the inside of the heel, with the tendon attaching at the base of the arch of the foot.   

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The role of the tibialis posterior muscle is to move the foot and ankle downwards and towards the midline of the body. The tibialis posterior also helps to support and maintain the arch of the foot. Tendinopathy is a broad term that refers to painful pathologies of the tissues in and around a tendon, usually related to overuse.

 

What are the symptoms?

 

Signs and symptoms of tibialis posterior tendinopathy can include pain and/or stiffness over the tendon, clicking or 'crepitus' sounds with movement and swelling. Pain can be felt both when you touch the tendon or with movements that involve contraction of the tibialis posterior muscle, such as when going up on to your toes, hopping or running. 

 

As the condition progresses, the tendon might be come weaker and elongated, providing less support to the arch of the foot. This might become more noticeable over time as the lack of support in the foot further aggravates the damaged tendon.  

 

Pain may become so severe that eventually running becomes too painful to continue and even walking may be sore. In some cases, the affected tendon may be weakened but painless. For some, a complete tear of a weakened tendon can be the first sign that anything is wrong.

 

What are the causes?

 

Like most tendinopathies, overuse and biomechanical errors are the main cause of tendon pathology. Prolonged or repetitive activities that place excessive strain on the tibialis posterior tendon can cause degeneration and disorganization of collagen fibres within the tendon.  

 

Excessive pronation or rolling in of the foot while walking can place the tendon under extra stress as it acts to support the arch. Unsupportive footwear can exacerbate this process as it allows the foot to roll inwards. Often, a person may not have any issues until they begin to increase their training. If tendons are subjected to too much load too quickly, they can begin to breakdown, developing into a tendinopathy.

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Being overweight, muscle weakness or tightness, poor warm up and insufficient recovery periods can all contribute to the development of tendinopathy. As you might expect, runners are most affected by this condition, along with other athletes of sports that require lots of running. Non- athletes can also be affected with day-to-day activities causing tendinopathy. 

 

How can physiotherapy help?

 

Your physiotherapist can help by making an accurate diagnosis in clinic, which can be confirmed by MRI or ultrasound. Your physiotherapist can also identify which factors may be involved in the development of this condition, helping to address them and reduce pain as quickly as possible.

 

For most tendinopathies, a period of relative rest is required and a graded training program to help strengthen the tendon has been shown to have the best evidence for recovery. Other interventions such as ultrasound, ice or heat treatment, soft tissue massage, stretching and joint mobilization may be used. Arch support taping, biomechanical correction, bracing and footwear advice may also be added.

 

None of the information in this article is a replacement for proper medical advice. If you believe you have problems with your feet or ankles, please book in with one of our experience Physiotherapists.

Osteoporosis

Osteoporosis

Osteoporosis is a condition characterized by very low bone mass or density. This is caused by the body either losing too much bone, not making enough or both. Osteoporotic bones become weak and fragile and can break from small forces that would normally be harmless.

In osteoporotic bones, as well as loss of bone density and mass, there may also be abnormal changes to the structure of the bone matrix, which further contributes to the bone weakness.

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Osteoporosis is an extremely common bone disease and women are more affected than men. As it is a progressive disorder that worsens with age, while the disease process might begin earlier, the effects are usually only noticed and diagnosed in people who are 50 years and older.

What are the Signs and Symptoms?

Often called a silent disease, many people with osteoporosis will have no idea that they have the disease, as there are no obvious symptoms. In fact, sometimes the first sign that an individual has osteoporosis is when the first bone is broken. Along with fractures, which are the most serious signs of this disease, osteoporosis can cause the upper back to become excessively hunched (itself often a result of spinal wedge fractures) and there maybe widespread pain as bony tissue is increasingly unable to withstand normal forces.

Fractures are a serious problem, especially in the elderly population. Bone breaks due to osteoporosis occur most frequently in the wrist, spine or hip. When the spine is affected by osteoporosis, people may develop a hunched or stooped posture, which can itself lead to respiratory issues and places pressure on the internal organs. Osteoporosis can severely impact a person’s mobility and independence, which can have a huge impact on quality of life.

What Causes It?

As this is primarily a metabolic disorder, there are a variety of things that can cause osteoporosis if they either interfere with the body’s ability to either produce bone tissue or encourage excessive breakdown. This can be anything from gastrointestinal conditions that prevent absorption of calcium, lack of dietary calcium or low levels vitamin D, which is essential for absorption of calcium.

Certain medications may also cause bone loss especially if they are taken for a long time or in high doses. A good example is the long-term use of steroids. Although steroids are used to treat various conditions, it has been proven that steroids can cause bone loss and eventually, osteoporosis.

As bones respond to force and weight bearing by building more bone, having a sedentary lifestyle or doing activities with low impact can also lead to osteoporosis and this has been shown be an issue amongst professional swimmers and cyclists.

How Can Physiotherapy Help?

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Physiotherapy can help you to improve your overall bone health, avoid or recover from fractures. Physiotherapy exercises can direct you to safely increase your weight bearing, which can help build bone mass. Balance training is also an important factor as this can reduce the risk of falls. Your physiotherapist can also educate you on how to adjust your lifestyle, at home or at work, to protect your bones and improve your posture.

Achilles Injuries - Not such a Greek Tragedy.

Achilles Injuries - Not such a Greek Tragedy.

What is it?

The Achilles tendon is a band of fibrous tissue located at the back of the ankle. Its main role is to connect the calf muscles to the heel bone. This tendon is the largest tendon in the body and when it tightens, as the calf muscles contract, it pulls the heel allowing you to stand on tiptoe or to point your foot.

Achilles tendon tears commonly occur in athletes, however, this injury can affect anyone and at any age. Surprisingly, a complete tear is actually more common than a partial tear.

These tears are commonly located at the part of the tendon where there is poor blood flow approximately 6cm above its attachment to the heel. Since there is poor blood supply, this part of the tendon is both vulnerable to injury and slow to heal.

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 What are the Symptoms?

Primarily, an Achilles tendon tear will cause difficulty in activities such as walking, running and jumping. Other signs and symptoms of an Achilles tendon tear include:

·         A loud pop or snap is heard

·         Sudden and severe pain at the back of the calf or ankle

·         Feeling of having been kicked in the calf

·         There is a gap between the tendon and the heel (about 6cm above the heel)

·         Swelling and stiffness followed by weakness and bruising

·         Difficulty walking, particularly during push off

·         Standing on tiptoe may be impossible

 

What Causes It?

Anyone can tear their Achilles tendon if the tendon is subject to excessive force or overstretching, however there are some factors that can increase your risk of injury. The most common activities that cause this injury are running and jumping.

The Achilles tendon can thin and weaken both as we age, and also if it is not used. As a result of this weakening, it becomes prone to injury like tear or rupture with less force or stretching required before an injury occurs. A tear of the Achilles is often observed in people with pre-existing Achilles tendinitis. Other factors such as certain medications including antibiotics and steroids and some illnesses like diabetes and arthritis can also result in weakness of the tendon, increasing injury risk. Being obese is also a risk factor as excess weight puts additional strain on the tendon.

How Can Physiotherapy Help?

The good news is Physiotherapy is a highly effective way to manage an Achilles injury. Overall management approach will depend on a number of factors including the patient’s age, how severe the injury is and the patient’s activity level. For young people especially athletes, they opt to have surgery followed by physiotherapy based rehabilitation while older, less active people can choose full conservative management including physiotherapy.

Physiotherapy treatment for an Achilles tendon tear will involve exercises to strengthen the calf muscles and the Achilles tendon and exercises for stability. Many people are able to return to their normal activities within 4 to 6 months. Functional rehabilitation is also part of the program as it focuses on how you coordinate your body and how to move it. The aim of functional rehabilitation is to help you return to your highest level of performance.

At Northside Sports Medicine our Physiotherapists are experienced in managing both conservative and post-operative Achilles injuries.

Injuries of the Knee - Medial Collateral Ligament (MCL)

Injuries of the Knee - Medial Collateral Ligament (MCL)

WHAT IS IT?

Your knee moves freely backwards and forwards; however the thought of it moving from side to side probably makes you cringe. This is because the knee joint has sturdy ligaments either side of it that prevent sideways movement and we instinctively know that a lot of force would be required to shift it in this direction.

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The ligaments on either side of the knee are called the MCL - Medial Collateral Ligament (found on the inside the knee) and the LCL - Lateral Collateral Ligament (found on the outside the knee) and they each work to provide stability and restrict the knee’s movement into a sideways direction.

 

HOW DOES THIS INJURY OCCUR?

 

The typical mechanism for this injury is a force that drives the lower leg sideways away from the upper leg. This can occur from an awkward landing from a height, or when twisting with a foot fixed on the ground or from an external force hitting the outside of the knee, such as with a rugby tackle.

 

WHAT ARE THE SYMPTOMS?

MCL tears have quite a distinctive set of symptoms, with pain and swelling noticed quite specifically to the inside of the knee. The severity of the pain and swelling will be related to the number of ligament fibres damaged. Larger tears will also make the knee feel unstable or loose.

 

To classify the severity of the injury and help to guide treatment, a grading system is used. With grade 1 indicating that a few ligament fibres have been torn and grade 3 used for a complete tear of the ligament with associated joint laxity. Very severe MCL tears often also involve injury to the medial meniscus and ACL and can require surgical repair. However, most MCL sprains can be managed well with physiotherapy. Grade 1 and 2 MCL sprains take between 2-8 weeks to fully heal and a complete rehabilitation program is strongly recommended to prevent future injury. 

 

HOW CAN PHYSIOTHERAPY HELP?

 

In the early stages of the injury, treatment is focused on pain and swelling management, while allowing the body to start the healing process through inflammation. This is best managed thought the R.I.C.E. principles (Rest, Ice, Compression and Elevation).

 

Following any injury, it is natural for muscles to waste a little and the damaged tissues to lose what we call proprioception, the ability to sense their own position in space. This loss of muscle strength and proprioception can contribute to further injury if not restored with a proper rehabilitation program.

 

Physiotherapy also aims to restore movement to the joint and support the ligament while healing to ensure that it is strong and healthy, and the scar tissue forms in an organized fashion, which makes the new ligament as strong as it can be and protects against future tears.

Acute Wry Neck

Acute Wry Neck

Have you ever woken up with an inexplicably stiff and painful neck that will only turn to one side? You might have been suffering from acute wry neck, a painful condition following a typical pattern of symptoms. In the clinic, wry neck is classified as one of two different types – Facet or Discogenic wry neck. These have similar presentations, yet are caused by slightly different things and require different treatment.

Facet Wry Neck:

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Facet joints are found on either side of each vertebrae of the spine and allow for controlled rotation and side bending. An awkward movement of the neck can cause a part of the joint capsule to tear or get caught in the joint, making it feel locked. The muscles around the area can also be come tight and spasm, which contributes to the problem. The pain is usually sharp and can be pin pointed quite accurately to the part of the neck causing the problem and the pain rarely travels down into the arm. It is usually possible to find a resting position where the pain goes away completely, only having pain when turning in certain directions.

The good news about Facet Wry Neck is that your physiotherapist is usually able to help you ‘unlock’ the neck quite quickly with gentle mobilisations and get you back into action. Most of the time a full recovery can be expected within a week.

Discogenic Wry Neck:

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Each of the vertebrae of the neck are separated by fibrous disc that are filled with a gelatinous center. These discs provide support, flexibility and

shock absorption. Under pressure, these discs may bulge or tear and the resulting swelling can cause pain and muscle spasm in the surrounding area. It is important to note that in an area as sensitive as the neck, a small amount of damage can result in a large amount of pain.

The development of discogenic wry neck is usually due to a combination of factors, including neck stiffness, poor posture and biomechanics than can contribute to the disc being vulnerable prior to injury. In this case it can be difficult to find a comfortable position and it is more likely for the pain to travel into the arm and may even be associated with pins and needles.

Treatment of discogenic wry neck will be focused on reducing pain and muscle spasm with massage, taping, heat and postural education. Further treatment aims to reduce any stress that is being placed on the disc, mobilise any stiff spinal segments and correct any muscle imbalances. While the initial symptoms may settle down quite quickly, it can take up to six weeks to fully recover from discogenic wry neck. In this condition it is also important to address all the factors that may cause a recurrence of the issue.

Our Physiotherapists are highly trained in recognising the different causes of neck pain. If you are unsure about your neck pain, book in to see one of our expert team.

Why do I have Tennis Elbow if I don't play Tennis?

Why do I have Tennis Elbow if I don't play Tennis?

WHAT IS TENNIS ELBOW?

Tennis Elbow (also known as Lateral Epicondylalgia) is pain associated with the outer aspect of the elbow, specifically over the bony prominence known as the lateral epicondyle. The lateral epicondyle is the anchor for the muscles that extend the wrist and fingers. It can begin as an acute injury or it can creep in slowly and without warning.

Tennis Elbow symptoms that have lasted more than six weeks will be considered to be sub-acute or chronic.

The usual area of pain for Tennis Elbow.

The usual area of pain for Tennis Elbow.

Typically the Tennis Elbow sufferer will experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when the muscles are stretched. There will be tenderness directly over the bony epicondyle, and there may be trigger points in the wrist muscles. Some sufferers will also have neck stiffness and tenderness at C5/6, as well as signs of nerve irritation. All elbow movements are typically be pain-free, despite that being the area of pain.

Tennis Elbow is associated with degenerative changes in the muscle tissues located at the epicondyle. Although for a long time this was thought to be related to inflammation from overuse, this is now known to be incorrect. Testing of Chronic Tennis Elbow sufferers has shown no evidence of the chemicals normally associated with inflammation. Rather there is an increase in chemicals associated with pain transmission in the nerves. This is coupled with changes in the blood supply, and changes in the co-ordination of the muscles when using the hand and wrist. This results in decreased ability to perform normal functional activities by reducing reaction time and speed, and reducing strength.

PHYSIOTHERAPY AND TENNIS ELBOW

Tennis Elbow occurs commonly in the community. It is present in 40% of all tennis players (hence it’s name) and 15% of people working in repetitive manual trades. It can occur at any age. However, sufferers are generally between the ages of 35 and 50. Predictably, the side affected is usually associated with handedness, but it can occur in the non-dominant arm. Males and Females are affected equally. Untreated Tennis Elbows can last anywhere from 6 months to 2 years, and are prone to recurrence.

Physiotherapy aims to achieve three things

Reduction of pain

Increase in muscle length

Restoration of normal movement patterns

There are many ways to achieve these ends and, following a thorough assessment of your arm and neck, your physiotherapist will discuss the best strategy for you to use based on your level of symptoms and your lifestyle. Results are typically measured through patient feedback and measurement of pain-free grip strength. Treatments can include gentle manipulation of your neck and elbow, releases to the trigger points in the arm, supportive taping and, of course, home stretches and exercises. Electrotherapy modalities such as ultrasound may also be used.

WHAT CAN I EXPECT FROM TREATMENT?

Studies have shown physiotherapy to be the most effective way of managing Tennis Elbow when compared to injections or giving of advice alone.

When given a 6 week course of physiotherapy comprising of 8 treatment sessions, most patients show significant improvement after 3 weeks, increasing to a 60% or greater recovery after 6 weeks of treatment. This improvement is shown to continue to around a 90% improvement at 12 months, even without further treatment.

By comparison, provision of advice only resulted in a recovery of 60% or greater being delayed a further 6 weeks, to three months. Over longer periods of time, patients given good advice did recover, and by 6 months had achieved similar gains to the treatment groups. This was maintained over time and continued to improve.

Cortisone injections resulted in very good initial improvements with almost 80% reduction in symptoms after 3 to 6 weeks. BUT (and it’s a big one) patients who received cortisone injections only showed an increase in pain after 6 weeks, and by 3 months had fallen well below both the physio treatment groups AND the advice only groups in terms of their recovery. This deterioration was followed by delayed healing, resulting in the cortisone injected group having almost 30% more pain after 12 months than if they had followed advice alone.

For this reason we do not recommend cortisone injections as a stand-alone treatment for Tennis elbow. Physiotherapy should always be considered as a part of your management. IF you need more information or advice in managing your Tennis Elbow, book in with one of our experienced clinicians.

All About Suitable Duties Programs

All About Suitable Duties Programs

Suitable Duties Programs should be provided to any worker returning to work following an injury. This can be provided by the company or, in the case of work related injury, in consultation with the case management team.

A suitable duties plan is a graduated work program that helps injured workers improve their work fitness.

When necessary, an allied health provider will visit the worksite with the worker to develop the program so that it matches the person's abilities with appropriate job tasks and working hours. These tasks and hours are often increased during the program as the worker recovers.

Early return to work is linked to better outcomes for both the Worker and the Employer

Worker Benefits

1.             Retaining full earning capacity

2.            Maintaining a productive mindset

3.            Staying on a regular work schedule

4.            Avoiding dependence on a disability system

5.            Having a sense of security and stability

Employer Benefits

1.            Anticipating and controlling hidden costs

2.            Reducing financial impact of workplace injuries

3.            Providing a proactive approach to cost containment

4.            Improving your ability to manage an injury claim and any restrictions

5.            Getting your experienced employees back to work, resulting in less time and money spent on recruiting and hiring.

There are some important things to consider to make sure a worker successfully completes their Suitable Duties Plan and makes a full and speedy return to work. Early intervention and a focus on returning to work decreased sick leave and increased the likelihood of a return to work. The strategy was found to be cost effective and improved the employee's self-reported health. Co-operation between healthcare providers, insurance companies and employers was found to be efficient in saving time and improving the relationship between the employee and the insurance company.

Integration of an Allied Health Professional like a Physiotherapist facilitated more timely changes to the workplace, rehabilitation and training.

Even though the upfront costs can be higher, studies have shown a 7 fold return on investment early in the workers injury. Put simply for every $1 spent on early intervention, $7 was gained in the long term through lower insurance premiums, fewer recruiting costs or adversarial claims. As an added bonus, interventions have been shown to decrease exposure to risk for other employees.

If you would like to learn more, or arrange for a review for yourself or one of your employees, please contact us. We are affiliated with all major Insurers, Workcover, Comcare and Garrison Health.

Call us on 3350 2596

Ankle Sprains

Ankle Sprains

Ankle sprains are one of the most common sporting injuries seen by healthcare professionals. They also tend to be one of the most repetitive. We all know that player on the team who has perpetually strapped ankles, and that will hobble off the field at least once every season.

So what happens when you sprain your ankle and what makes some ankles more susceptible to injury than others? Why do some people seem to recover faster than others, and not go on to have long term problems?

The ankle joint is comprised of the mortise formed by the ends of the lower leg bones (tibia and fibula), and the talus, a dome shaped wedge of bone. Together they act somewhat like a hinge for the foot. The joint is surrounded by a capsule like the other synovial joints, and ligaments re-enforce this. It is typically the ligaments that bear most of the damage when the ankle is twisted too far.

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There are also some important ligaments at the bottom of the lower leg that can be injured. They are often referred to as the syndesmosis, and are the structures injured in a "high" ankle sprain.

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The vast majority of ankle sprains (more than 95%) are Inversion Sprains. These occur when the  ankle rolls and the foot twists under you. They are more prevalent as the ligaments on the outside of the ankle are smaller than the ones on the inside. Syndesmosis injuries are more common than medial ankle sprains, and are linked to longer term pain, later return to sport and re-injury.

Ankle sprains are assessed on their severity by how badly damaged the ligaments are. This is usually assessed by feeling for looseness in the ankle. Sometimes radiology can be used to help assess the ankle for other injuries. How severe the sprain, and therefore how much bruising and swelling there are will have a significant effect on how quickly someone can return to activity. Simple sprains may only need a few weeks rest, however is some cases people report pain and instability for 6 months or more post injury.

Assessment of your ankle by an experienced physiotherapist or doctor is important to determine both the severity of the injury, and to ensure there are no significant problems that may need further investigations, like a fracture. Sometimes severe ankle sprains can only be corrected by surgery (Although this is usually only looked at if conservative rehab has failed).

Early management of an ankle sprain is fairly consistent, regardless of severity. The subsequent stages of rehabilitation will be moved through at a rate determined by the severity of the injury. Healing and return to activity will be optimised by paying attention to the following stages of recovery.

Stage 1 - Rice

Good old Rest - Ice - Compression - Elevation. In terms of rest, severe ankle sprains should spend a couple of days on crutches, or until you can weight bear without too much pain. Simple elastic bandages will provide good compression. Occasionally a severe sprain may be put into a moon boot. This protects the injury and helps improve mobility by reducing pain.

Stage 2 - ROM/Flexibility Exercises

Early movement is very helpful for joint sprains. Even if a period of immobility is needed post injury, range of movement exercises will be one of the first things you commence. These will include both exercises to move the joint and exercises to stretch the muscles.

Stage 3 - Strengthening Exercises

While the ankle joint is painful and swollen, the muscles in that area become weakened, and need to be strengthened again to allow normal movement to return. Some of these muscles are to provide power to the foot and ankle, e.g. the calf. Other muscles like the peroneals contribute both strength and stability to the ankle. Rehabilitation of these muscles is crucial to help prevent re-injury.

Peroneal Muscles

Peroneal Muscles

Calf muscles

Calf muscles

Stage 4 - Proprioception and Balance Exercises

Balance exercises help retrain the normal reflex reactions of the ankle to sudden load or stress, from changing direction or from stepping on uneven ground. You have felt these systems at work if you have experienced a "near miss" ankle sprain. This is when you can feel the ankle starting to roll, but it suddenly pops back underneath you. Reflex muscle actions in the leg are responsible for correcting your position automatically. It is imperative to retrain these systems after injury to reduce the likelihood of re-injury.

Stage 5 - Agility and Endurance

In this stage you will start to perform more athletic exercises designed to restore your agility and strength for return to sport or activity. Sometimes there are Sport Specific exercises that may be performed to prepare you for specific activities.

Stage 6 - Return to Sport

In the return to sport phase you will steadily return to normal training and playing. Normally your physiotherapist will guide you back through different intensities of training skill ranges to ensure a safe return. They may also give you advice regarding taping and bracing of your ankle to give it extra support when you return to sport. You can read more about the differences between taping and bracing in our earlier post on the topic here.

If you would like your ankle injury expertly assessed and receive the best advice for return to sport, book an appointment with one of our Physiotherapists today. Go to our Online Bookings page or call us on 07 3350 2596.

What is Scaption and Why is it Important?

What is Scaption and Why is it Important?

The term scaption was first coined in 1991. It was a contraction of Scapular Plane Elevation. It refers to lifting the arms from the sides in a slightly forward alignment.

 This position aligns with the normal anatomy of the shoulder joint. Physios often use scaption as both an assessment and rehab point. It is particularly important for assessing the function of the shoulder blade.

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The shoulder blade is an extremely important part of shoulder rehab. In normal movement it rotates and elevates to change the position of the shoulder joint, providing a combination of strength and stability. It’s function relies mainly on good balance between 3 muscles.

·         Upper Trapezius

·         Lower Trapezius

·         Serratus Anterior

Any loss of balance in these muscles can lead to poor shoulder movement and result in impingement and pain, as well as reduced function.

While it is hard to isolate these muscles from each other, certain positions and exercises will highlight or exaggerate the function of one of these parts.

Let’s look at 3 simple exercises that you can use to train the scapular stabilisers. Each exercise will emphasise a different muscle.

Upper Trapezius Muscle is usually the most dominant, but will sometimes need strengthening. Lifting to the side to 90 degrees will emphasise its action.

Lower fibres of Trapezius are often underactive in shoulder pathology. Especially in desk workers.

The muscle most responsible for the correct rotation of the shoulder blade is the Serratus Anterior Muscle. It runs from the inside border of the scapula and wraps around to attach to the lateral trunk wall.

With any exercise program, having correct technique and appropriate progression of your exercises is critical. All of our Physios are highly experienced in identifying incorrect movements that lead to pain and pathology, and in providing appropriate exercise to correct them. We are happy to work with your Personal Trainer to guide your recovery. Gym visits for more advanced programming can also be arranged.

The Effects of Sleep on Rehabilitation

The Effects of Sleep on Rehabilitation

So, you have been to the Doctor and the Physio. You have had your rehabilitation for your injury mapped out and you have started your first exercise program. Chances are that you are learning new movements and habits, so you are really concentrating on getting it right. You are so keen to get back to training and sports (or just back to work) that you will do ANYTHING    to accelerate your progress.

Ok then. I am going to tell you what to do next.

·         Put down your phone

·         Turn off the TV

·         Go to bed

Sounds pretty easy right? Except you have almost nailed that level of Candy Crush and that repeat of Big Bang Theory that you have only seen 3 times is on next, you know, the really funny one where Sheldon does something weird! And it is sooo early. It’s only 9pm! You have plenty of time to finish the level, watch the show and be in bed by 10:30; 11 latest…

When your alarm goes the next morning at 6am you will have had 7 hours or fewer sleep. No big deal you think. I do it all the time. 

Unfortunately, it is a big deal.

Meta-Analysis of decades of sleep research shows very strongly that sleep deprivation, even in the short term, has a negative impact on just about every aspect of performance. We become less competent at motor tasks (moving) and even worse at cognitive tasks (thinking).

Just how pronounced is this effect? One large analysis from Bradley University looked at combined data from 19 original studies and found that the average functioning of sleep deprived subjects was almost 1.4 standard deviations worse than the non sleep deprived subjects. Put another way they performed in the 9th percentile, meaning they were only as effective, on average, as the bottom 10% of the subjects that got a good night’s sleep.

Still need convincing?

Sleeping less than seven hours a night is linked to greater risks of 10 different diseases  

 Heart attack      -              29.2%

 Heart disease   -             27.7%

 Stroke                  -              33.3%

 Asthma               -              28.5%

 Lung disease     -              45.4%

 Cancer                 -              3.9%

 Arthritis               -              28.9%

 Depression        -              36.2%

 Kidney disease -              33.3%

 Diabetes             -              22.5%


“The epidemiological evidence is clear: the shorter your sleep, the shorter your life!”'  Dr Matthew Walker, Sleep Researcher @sleepdiplomat

 

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So how do you go about getting more sleep? WebMD suggests some of the following helpful tips.

1)      Power down. Turn off screens an hour before bed and eliminate light sources in your bedroom.

2)      Try not to nap during the day.

3)      Set your body clock. Try and go to sleep and get up at consistent times (even on the weekend)

4)      Avoid caffeine in the afternoon and evening.

5)      Exercise.

6)      Don’t eat a heavy meal just before bedtime.

Having a good pillow and mattress will also help. Get your physio to show you suitable sleeping positions if you suffer from back or neck pain.
 

Government Ends Over the Counter Sales of Codeine. What Does it Mean for my Back Pain?

There has been lots of press in the last couple of weeks regarding the Federal Government's decision to ban over the counter sales of some pain medications. Specifically those containing codeine. Understandably there are a lot of people who are used to being able to purchase these medications who are now frustrated. It is important to remember that these medications are still available on prescription and one of the purposes of changing their availability is to to get people back to their GPs to discuss the best ways to manage their pain.

There are many approaches to managing pain. Some are more effective than others. Some people's pain will go away completely. Some people's pain will remain. All pain needs to be managed though. This management may well contain codeine or other drugs. Depending on your type of pain there are options that can be far more effective. There is plenty of evidence that combining medications with other interventions is more effective than medications alone. This includes things like manual therapies, exercise, diet and education.

If you are feeling anxious about the new legislation, we would encourage you to seek information from your GP or Registered Health Professional. Our Physiotherapists and Sports and Exercise Medicine Doctors are highly experienced in managing pain, especially pain of an orthopaedic (muscle, bone and joint) origin. Call us on 3350 2596 or book online.

To help you understand the current, clinically supported strategies for managing back pain, have a look at this great little video by Dr. Mike Evans.

Bracing vs Taping. What's your preference?

Do you brace or do you tape? What do you think is the best way to protect an injury when returning to sport? 

 

Most people have a preference, whether they use a brace or strapping tape when protecting an old injury. Some swear by one or the other. Some people even do both. But what does the research say?


Most studies have looked at ankle injury prevention as this is one of the most common sporting injuries. Simple sprains of the ankle are most common overall. In the case of ankle injuries both taping and bracing were found to be of similar benefit in preventing re-injury. In terms of cost however, bracing was significantly (3 times) cheaper than taping in the long term.


Taping knee injuries is less clear. There is very strong anecdotal evidence for various types of taping, especially around protecting ligament injuries and some tracking problems in the kneecap, but the evidence in the literature is unclear. Unfortunately many sports exclude all but the simplest of knee braces to prevent injury to other players.


There are some simple guidelines that are worth following if you do decide to use strapping tape.
• Placing the athlete in an appropriate position.
• Appropriate selection of:
     o A comfortable table height and position that is appropriate for the health care provider to minimise strain and                     fatigue.
     o Type and width of the tape. • Application of tape:
     o To a dry and clean area and at body temperature.
     o Immediately after cryotherapy or hydrotherapy is to be prevented.
• Taping should be:
     o Prevented at the site of perspiration.
     o Applied directly on skin or on under-wrap.
     o Done on skin with the tape adherent to prevent slippage.
• Areas subjected to friction blisters should be covered with protective pads or under-wraps.
• While applying tape, the following should be kept in mind:
     o It should be firm, yet smooth and wrinkle free
     o There should not be impairment of normal circulation, normal movement of muscles and tendons present                            underneath the tape.
     o Avoid pressure on bony prominences.
     o Any tingling, numbness, decreased tactile sensations or impaired distal venous return should be monitored and                  taken care of immediately, if noted.
• The tape is to be broken or torn in an extended or stretched fashion to avoid folded edges
• Removal of tape should be done following the proper methods by using tape cutters and specially designed scissors
• The skin has to be cleaned adequately of the tape residue
• Any blisters or skin abrasions, if noted, should be taken care of immediately

At Northside Sports Medicine we have access to a wide range of braces for acute and long term injury protection. We also stock a variety of sizes of rigid tape as well as kinesiotape (rock tape). 

Sit to Stand Workstations. What’s the verdict? – by Rohan Davies

Sit to stand workstations are becoming increasingly popular in the workplace. Increasingly they are being recommended for people with sedentary (sitting) roles, but are they worth the extra investment?

We know that there are risks associated with sedentary behaviour including an increased risk of negative health outcomes such as Type II diabetes, metabolic syndrome, cardiovascular disease, heart attacks and strokes. Long term public health initiatives have worked towards encouraging increased physical activity to offset our increasingly sedentary lifestyles.

A surprising finding in more recent research is that the risks associated with sedentary behaviour are independent of physical activity. Put simply, if you meet you daily exercise requirements you can still have risk factors associated with long periods of sitting. If you have an office job, it is not enough to go out and exercise away from work. We need to get moving more during the day as well.

Current recommendations from Public Health England suggest that workers in sedentary occupations should move towards 2 hours of movement during an 8-hour workday initially, building up to 4 hours in the long term. The first of these targets is reasonably easy to achieve for many people. Studies show varied amounts depending on industry and role, but we can state that on average a sedentary worker will spend around 1.5 hours moving during a typical work day. Building in an extra 30 minutes can be a simple as taking the stairs, moving to a colleague’s desk to talk instead of emailing, or just going for a short walk in your break. Adding another 2 hours on top of this can be more challenging, however.

Sit to stand workstations have been shown to be effective in reduction of time spent sitting at work. Research also shows a related improvement in perceived wellbeing and reduction in pain. Importantly for employers, there is no reduction in productivity.

As with everything there is a down-side. Extended periods of time standing brings its own array of health problems including the potential for back pain, leg pain and venous disorders. Ultimately you can have too much of a good thing.

In summary, Sit to Stand Workstations are one of many tools that can be used to improve health in the Workplace. Current recommendations support their introduction, but it should be noted that training in the correct use and, ultimately, compliance is critical to the success of implementation. Sit to Stand Workstations should be introduced in partnership with an experienced provider and Human Resources support.

Rohan Davies has 20 years experience as a Clinical Physiotherapist and is a Member of the Occupational Health Group of the Australian Physiotherapy Association. If you would like further information on implementing Sit to Stand Workstations in your business or to discuss any other Workplace Health issues please call 3350 2596 to arrange an obligation free meeting.

*Literature References available

Heel Pain

Heel Pain

Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (plantar fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. There is also a type of heel pain specific to children called Sever’s disease.

Even though heel pain can be severe and sometimes disabling, it is rarely a health threat. Heel pain is typically mild and usually disappears on its own; however, in some cases the pain may persist and become chronic (long-term).

What can be done about heel pain?

First a bit of science so you can better appreciate just what your foot has to deal with on a daily basis. There are 26 bones in the human foot, of which the heel bone is the largest. The human heel is designed to provide a rigid support for the weight of the body. When we are walking or running it absorbs the impact of the foot when it hits the ground, and springs us forward into our next stride. The stress placed on the feet when walking 1.25 times our body weight, and this increases to nearly 3 times when running. As a result, the heel is extremely vulnerable to damage, and pain.

In the majority of cases, heel pain has a mechanical cause.

Common causes of heel pain include:

Plantar fasciitis - inflammation of the strong bowstring-like ligament that runs from the calcaneum (heel bone) to the tip of the foot.

When the plantar fasciitis is stretched too far its soft tissue fibers become damaged and inflamed, usually where it attaches to the heel bone The patient experiences pain under the foot, especially after long periods of rest. It is often described like walking with a stone under the heel.

Heel bursitis - inflammation of the sack of fluid that sits between the heel bone and the Achilles tendon. Can be caused by landing awkwardly or hard on the heels. It is commonly caused by pressure from footwear. Pain is typically felt either deep inside the heel or at the back of the heel. It can also be associated with Achilles tendinopathy.

Heel bumps (common in teenagers). The heel bone is not yet fully mature and rubs excessively, resulting in the formation of too much bone. It can be caused by having a flat foot. Among females it can be caused by starting to wear high heels before the bone is fully mature.

Tarsal tunnel syndrome – a trapped nerve in the back of the foot.

Chronic inflammation of the heel pad – This occurs as the fibrous fatty pad under the heel begins to wear out and become inflamed.

Stress fracture – this is particularly common in runners, especially those with poor running mechanics.

Severs disease – this is the most common cause of heel pain in child/teenage athletes, caused by irritation of the growth plates of the calcaneus (heel bone). Children aged from 7-15 are most commonly affected.

Achilles tendonosis (degenerative tendinopathy) - also referred to as tendonitis, tendinosis and tendinopathy. This is a chronic (long-term) condition associated with the degeneration of the Achilles tendon. Sometimes the Achilles tendon does not function properly because of multiple, minor tears of the tendon, which cannot heal and repair correctly - the Achilles tendon receives more tension than it can cope with and microscopic tears develop. Eventually, the tendon thickens, weakens and becomes painful. Commonly the overload of the Achilles tendon is associated with other weakness in the hips and knees.

 

Treatment options

Obviously the best treatment options depend on the specific cause of heel pain and the severity. It is also dependent on patient variables such as age, sport/activity level, other injuries and comorbidities.

Broadly though treatment can be divided into the following groups.

Medication – many of the above conditions respond to Non-steroidal Anti-inflammatory Drugs (NSAIDs). On some occasions, steroidal drugs such as Cortisone may be injected into the painful area.

Physiotherapy and exercise – All of the above conditions respond well to suitable physiotherapy intervention, and often it is used in conjunction with other methods to manage the problem. Interventions can include manual therapy to release tight structures, electrotherapy and exercise. Depending on the specific condition the type of treatments and exercises applied can vary so getting an accurate diagnosis of the problem is extremely important.

Podiatry – Naturally a problem in the foot area will get benefit from podiatry. Generally, if the problem is coming from poor walking habits and biomechanics, then orthotics can quickly correct poor movement habits and enable correct walking and performance of exercises. Often getting advice on the correct footwear can have a big impact as well.

If you are having problems with foot pain or would like further information, call our friendly team on 3350 2596. Our Physiotherapists and Sports Physicians have extensive experience in treating heel pain of all kinds.

One little muscle. So many problems!

There is one muscle in the hip that does the lion's share of providing stability. Do you know which one?

Gluteus medius, the middle gluteal/buttock muscle is massively important in stabilising the pelvis, especially when loading on a single leg. If it isn't working properly then the body cannot keep the pelvis aligned when walking or running, and that can lead to big problems.

Poor pelvic control in gait is linked to Low Back Pain, Tibial and Foot Stress Fractures, Anterior Knee Pain, Cruciate Ligament Injuries and ITB Friction Syndrome. How can a single muscle do so much? Let's have a look at it's anatomy.

Gluteus Medius

Gluteus Medius

Gluteus Medius is a hip abductor. It starts on the crest of the pelvis, the bony ridge at the top of your hips. It has three distinct heads that all run to the greater trochanter of the femur (the bony knob on the outside of your hip). It is ideally positioned to keep the pelvis level no matter how flexed or extended the hip joint is. If it works well when you stand on one leg your pelvis will stay level and steady. If it is weak or injured then your pelvis tends to drop to one side. This is known as Trendelenberg's Sign. When it happens in walking it is sometimes known as Trendelenberg's Gait. If your Physio has ever watched you walk up and down the corridor, chances are this is one of the things they are looking for.

You can check yourself in the mirror at home. Sometimes the pelvis will appear to stay level even when the muscles are weak by the hip dropping to the side. Try standing on one leg. If one side of your pelvis drops or your hip drifts out to the side then you likely have a weak Gluteus Medius.

Rehabilitating Gluteus Medius is actually pretty straight forward once you know you have a problem. Management usually starts with awareness exercise in side-lying to identify what the muscle feels like when it fires. Specific exercises may be given for some or all the heads. Load is gradually increased until more functional exercises can be included to strengthen the muscle. This often also involved correction of poor technique and habits that have developed with the weakness.

So if you have a niggle in your knee that won't go away or a feeling in your foot that is ruining your day, maybe, just maybe your hip is the culprit.

For more information or to see if you could benefit from a hip tune up, why not contact our team or book an appointment online.

Can Kids Get Overuse Injuries?

Can Kids Get Overuse Injuries?

Did you know that 1 in 4 Australian children are classified as overweight or obese. There has never been a better time to encourage our children to participate in sport. The more sport a child plays, the less the chance of diabetes and heart disease in adulthood.

The good news is that about two thirds of Australian kids regularly do competitive sports – whether at school, in weekend local competitions, or at the state and national competition level.

BUT CAN YOU HAVE TOO MUCH OF A GOOD THING?

It isn’t hard to understand that the more sport the child plays, the greater the risk of injury. The risk is low in the under 10s – but accelerates from about the age of 12 on. That's when kids, aware of their increased body and muscle strength after puberty, start to get more serious about sport and pursue it aggressively (boys especially). They train more often and harder. They may play sport all year round and they may play more than one sport at a time.

Most acute injuries are from falls (especially in netball and soccer), or being hit by another player (as in a tackle in rugby and Aussie rules).

The biggest cause of injuries (about 60 per cent) is overuse – where a bone, muscle or tendon is repeatedly used far more than it was designed to be. The tissues become damaged, and because the child keeps using them, they don't get a chance to heal and the injury becomes chronic.

WHAT SHOULD I BE ON THE LOOK OUT FOR?

There are 4 stages to overuse injuries in sport.

  1. Pain in the affected area after physical activity

  2. Pain during physical activity, not restricting performance

  3. Pain during physical activity, restricting performance

  4. Chronic, persistent pain even at rest

 Sometimes the child doesn't make the connection between the pain and the sport because the symptoms may be vague and fatigue and poor performance are more troubling than the pain.

If it continues, overuse can lead to 'burnout'.

WHAT CHILDREN ARE MOST AT RISK?

Kids most at risk from overuse injury are those:

  • who play the same sport on more than one team, or who play several different sports.

  • who don't take breaks from sport and training.

  • who play all weekend.

The American Academy of Paediatrics has posted the following guidelines for parents and coaches to help prevent overuse injuries in children.

1.       Encourage athletes to try to have at least 1 to 2 days off per week from competitive athletics, sport-specific training, and competitive practice to allow them to recover both physically and psychologically.

2.       Advise children and coaches that the weekly training time, number of repetitions, or total distance should not increase by more than 10% each week.

3.       Encourage the child to take at least 2 to 3 months away from a specific sport during the year.

4.       Emphasize that the focus of sports participation should be on fun, skill acquisition, safety, and sportsmanship.

5.       Encourage the athlete to participate on only 1 team during a season. If the athlete is also a member of a traveling or rep’ team, then that participation time should be incorporated into the training program rather than tacked on.

6.       Encourage the development of educational opportunities for children, parents, and coaches to provide information about appropriate nutrition and fluids, sport safety, and the avoidance of overtraining to achieve optimal performance and good health.

7.       Convey a special caution to parents with younger athletes who participate in multigame tournaments in short periods of time.

If the child complains of non-specific muscle or joint problems, fatigue, or lack of enthusiasm about practice or competition, it could be burnout. Take the child to a GP, a sports physician or a physiotherapist.

AT NORTHSIDE SPORTS MEDICINE WE HAVE CLINICIANS EXPERIENCED IN SCREENING FOR OVERUSE INJURIES AS WELL AS MANAGING YOUNG ATHLETES WHO ALREADY HAVE PROBLEMS. CONTACT OUR TEAM OF PROFESSIONALS TODAY AND STAY IN THE GAME.