April 26, 2019Matthew LewingtonUncategorized

One of the regular questions we receive in the clinic, particularly in the Good Living with Arthritis: Denmark (GLA:D) program, is whether participants should exercise or attend the class when they are experiencing pain.

In relation to aches and pains that are not traumatic or acute in nature, the answer is “definitely yes”.  However, prior to commencing any exercises, it is best to have the cause of the pain assessed by one of our physiotherapists to ensure exercising is safe for you.

Once the cause of your pain has been assessed and you are reassured that it is safe to exercise, the best way to guide your levels/intensity of exercising whilst in pain is done using the following three body responses to the exercise:

1. Pain levels DURING the exercise

Pain levels should go up slightly but need to remain in the “acceptable” range.  This is generally between 3/10 to 5/10.  Any lower and your body won’t be challenged enough to make a positive change. Any higher, and you may risk causing an inflammatory response or worsen the underlying cause of the pain.

2. Pain symptoms in the following 24 hours AFTER the exercise.

Pain levels should return to the pre-exercise levels within 24 hours.  It is okay, and often anticipated, to be a little sorer the following morning, but this should subside by the time you are up and about with your daily activities.

3. How the pain levels TREND over time.

In isolation, an increase in pain can be alarming and especially when you are just commencing exercises with your pain.  However, by keeping track of your pain levels over time, the general trend should point towards you improving your pain levels.

A great example of trending pain is from one of our participants in the GLA:D program, who was initially skeptical about exercising whilst in pain.  This is a very common concern.  However, as can be seen, the trend over the 12 sessions (6 weeks) of the program is downward.  Remarkably, this was in conjunction with a significant increase in the participant’s loading capacity with their exercises.

So if you are suffering pain, book in with one of our physiotherapists and start your road to recovery and return to function.

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April 26, 2019Matthew LewingtonUncategorized

What is it?

FAI is a clinical disorder that describes the contact between the femoral head (ball) and acetabulum (socket) of the hip. This process alone does not cause pain however when coupled with vigorous, repetitive, excessive or restricted hip movement pain may occur

How is it diagnosed?

FAI can be diagnosed with a combination of signs, symptoms and imaging.

1. Symptoms – movement or position related groin pain, clicking, catching, locking, giving-way, hip stiffness, reduced hip movement
2. Clinical signs – typically restricted hip internal rotation movement and positive impingement signs (as assessed by your physiotherapist)
3. Diagnostic imaging – x-ray initially to identify any changes in the hip joint shape

What is the best treatment/management?

A physiotherapist led rehabilitation program that aims to improve hip strength, flexibility and control is the best and first line management for FAI. Education as well as life-style and activity modification are also thought to be beneficial (Griffin et al., 2016).

How can we help?

Our team at Enhance physiotherapy are experts in hip rehabilitation and will therefore tailor an individualised program to address the specific factors that contribute to your symptomatic FAI.

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April 18, 2019Matthew LewingtonUncategorized

Shin splints are a common lower limb injury in individuals that partake in running or impact sports. “Shin Splints” is a collective term used to describe a number of conditions that fall under “Medial Tibial Stress Syndrome” (MTSS). Generally shin pain arises from either or a combination of Muscular involvement, Tenoperiosteum (junction where tissue attaches to bone) and/or bone.

There are two areas in which you can experience shin splints:

1. Anterior Shin Splints (Front)
2. Posterior Shin Splints (Middle/Rear)

Anterior Shin Splints:
Anterior shin splints are located on the front part of the shin bone and involve the tibialis anterior muscle. The function of the tibialis anterior muscle is to lift and lower your foot. It lifts your foot during the swing phase of a stride, then it slowly lowers your foot to prepare your foot for the standing phase.

Posterior Shin Splints:
Posterior shin splints are located on the inside rear part of the shin bone and involve the tibialis posterior muscle. The function of the tibialis posterior is to lift and control the inside aspect of your foot/arch during the standing phase.

What are the symptoms of shin splints?

The condition commonly presents in both legs at the same time with one leg often being worse than the other. At first, discomfort may only be present at the beginning of exercise and feel to “warm up” during exercise, but then reappear once cooled down after activity. As the condition progresses the pain tends to stay during activity and can be severe, enough to limit the person from continuing activity.
The pain may also last hours after activity at this stage.

Individuals often describe a dull, aching pain in the front, inside aspect of the lower leg and can progress to sharp shooting pains with running and impact.
The inside and front of the shins are often tender to touch and depending on the cause and severity will determine the extent and pain location.

Individuals further often experience a feeling or tight or fatigued calves whilst exercises and may have some associated foot pain.

What increases the risk of shin splints?

• Females are 2-3 x more likely to develop shin splints compared to Males,
• Sudden increase in training (frequency, intensity, duration),
• Insufficient rest between loads
• Running, impact or sports on hard surfaces,
• Changes in footwear/inappropriate footwear
• Foot type
• Weak/inactive muscles
• Decreased ankle mobility
• Biomechanical abnormalities and training errors.

What to do if I have shin splints?

Treatment is dependant on the underlying causes identified by your Physiotherapist. Our Physiotherapists complete a thorough bio-mechanical assessment to determine the cause of your shin splints and further tailor an appropriate individualised rehabilitation program for you. If you are experiencing shin splints that are stopping you from doing what you love, don’t just rest and wait, jump online and book an appointment at Enhance Physiotherapy today.

Take Home Message:

Shin Splints or (MTSS) refers to pain in the front or inside of the shin and is a result of overloading of the bone or muscles in that region. Addressing the issue early is important to prevent it progressing into a more serious grading or bone stress response /fracture injury which requires rest from impact activities such as running.

There are many different causes of Shin Splints and therefore it is important you get assessed by a Physiotherapist to determine the underlying causes and further develop an appropriate rehabilitation program.
A graded running/training program and screening for mobility and muscle imbalances are a great way at reducing the risk of developing this common injury.

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April 16, 2019Matthew LewingtonUncategorized

What is it?

Fibromyalgia is a chronic condition characterised by widespread pain throughout the body along with fatigue, memory problems, sleep and mood disorders. Sufferers of fibromyalgia often spend years trying to find a diagnosis that fits their many symptoms and fluctuate between periods of having high energy and ‘crashes’ of fatigue and pain. In severe cases, fibromyalgia can cause significant lifestyle disruptions, including reduced activity, unemployment and depression.

The underlying mechanism that creates the symptoms of fibromyalgia has been shown to be increased pain amplification by the central nervous system and reduced activation of the sympathetic nervous system. Essentially this means that small pain signals in the body are processed as large pain signals by the central nervous system.

What causes it?

Fibromyalgia is a complicated condition that is poorly understood. This can be very frustrating for sufferers, who often find themselves being shuffled between health practitioners looking for answers and long term relief. While the pain generally feels muscular, usually little to no muscular damage or injury can be found on physical assessment. The symptoms can also mimic those of an infectious illness, or other chronic diseases. Often a diagnosis of fibromyalgia is reached after other diseases and causes have been ruled out.

The cause of fibromyalgia is as yet unknown, it was thought that the depression and reduced activity that are often associated with fibromyalgia could be causative, however it has been show that these are symptoms of fibromyalgia rather than causes. Other significant signs of fibromyalgia are a lack of REM sleep in sufferers and a positive result of more than 11 out of 18 muscular trigger points.

What is the treatment?

Following a diagnosis of fibromyalgia, patients primary strategy is to understand and manage their symptoms. This can involve pacing activities and balancing exercise so as to reduce ‘crashes’ and unhelpful pain cycles that lead to frustration. Identifying activities, employment and a routine that don’t exacerbate symptoms can have a significant impact on quality of life for someone with fibromyalgia. Having psychological support can also be very important to help patients deal with the emotional distress of a complex chronic condition that has no outward physical signs.

Treatments that have been shown to help reduce symptoms include hyperbaric chambers which can increase the patients energy levels, and floatation therapy which can help to settle the patients overactive central nervous system. Education and understanding of this condition can have the largest impact for sufferers, helping them to manage and maintain some control over their symptoms. Physiotherapists can have a large role in education and helping patients find a routine and activity level that helps them manage their condition as best as possible.

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April 12, 2019Matthew LewingtonUncategorized

Over the years since I, Dave Rossiter, graduated as a Physiotherapist, I have noticed a significant change in the way people with knee osteoarthritis have been advised to manage their condition.  In my first role as a graduate rotational physiotherapist at the Albury Base Hospital back in 2004, I completed rotations through the Orthopaedic Ward.  There, I regularly treated patients as young as 50-55 who had undergone a total knee replacement due to the pain and functional effects of osteoarthritis. However, back then it was often anticipated that a total knee replacement would only last 12-15 years.

Fast forwarding 15 years, much has changed in the management of knee osteoarthritis.  There are now mainstream use of uni-condylar (or partial) knee replacements in lieu of replacing the whole joint in suitable candidates.  More people are being recommended to gain education about the management of Osteoarthritis, exercise and manage their weight in accordance with the recently updated Royal Australian College of General Practitioners guideline on the management of hip and knee osteoarthritis.

Through the use of exercise and education programs like the GLA:D program, we are now seeing patients extend the life of their osteoarthritic hips and knees into their mid 60’s, which is much more preferential in terms of reducing the need for revisions due to the prosthetic wearing out.  Given the increase in total knee joint replacements raised by 29% from 2005/6 to 2014/15 and the projected prevalence of osteoarthritis (all forms) in 2030 will be 900,000 people just in the 65-74 age bracket, it is definitely going to become a primary goal to implement the best practices available

However, the question still remains, just how long can we expect a total knee replacement to last.

A systematic review of case studies around the world was recently undertaken by J.T Evans et. al. (2019) and appeared in The Lancet. In this review, 30 case studies with follow-ups in excess of 15 years were analyzed, totaling 6,490 total knee replacements and 742 uni-condylar knee replacements.  The pooled results of each group, taking into account the various types and manufacturers of the prostheses, revealed

• Survivability of a total knee replacement was 3% at 15 yearsand 94.8% at 20 years.
• Survivability of a uni-condylar knee replacement was 5% at 15 yearsand 81.9% at 20 years.

The clinical implications of this study include having greater awareness about the longevity of a total knee replacement prosthesis.  With the average age of the population increasing, and more people in the 35-55 age group being diagnosed with osteoarthritis of the knee, the timeframe of a knee replacement can impact on choice of surgical versus conservative management.

If you would like to discuss these findings and review how we can assist with any conservative management options or would like more information about our GLA:D program, please contact the clinic on (02) 6041 3609.

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April 11, 2019Matthew LewingtonUncategorized

With so many different types of running shoes available, it can be hard to know what to look for and which one will suit your activity and foot type. Should you go for a minimalist shoe or an anti-pronating shoe? A pure running shoe or a cross trainer?

Generally, shoes can be broken down by the amount of support and shock absorption that they provide. Shoes that are minimalist or free running type shoes provide little external support to the foot and encourage increased muscle activation for stability and force generation. The also provide limited shock absorption to the foot and lower limb. This style of shoe may not be suitable for some runners, particularly if you are new to running or doing longer distances.

As you move through the levels of support, shoes generally provide counters to over pronation of the foot (rolling in) and higher levels of shock absorption. Running shoes differ from cross trainers as they generally have more cushioning in the heel to absorb the impact of running and can have less sole in contact with the ground.  Cross trainers tend to have flatter soles and can be wider to assist with more dynamic movement and strength training. These shoes are great for a range of different exercise however may not be the most comfortable option for running.

Generally, there is no one shoe for each of us. You may benefit from a couple of different style shoes. Your exercise preferences and foot type will determine the level of support and shoe style that will make you more comfortable. It is recommended that running shoes are replaced every 6-12 months depending on the amount and type of running or exercise you are doing.

If you are looking to replace your current running shoes or are having some reoccurring symptoms in your feet, ankles or knees with exercise, contact us on 60413609 or book online with one of the Enhance Physiotherapy Team for advice on what running shoe may best suit you.

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April 5, 2019Matthew LewingtonUncategorized

Osteoarthritis (OA) is a leading cause of disability in older adults and can severely impact quality of life. Obesity is a major risk factor for development of OA as the extra weight increases the load on the joint.

Approximately, 80% of affected individuals have some degree of movement limitation, while 25% are unable to perform major activities of daily living. Often a ‘go to’ treatment recommendation from health professionals for people with OA is to ‘lose weight’ – which is far easier said than done but a a 10% reduction in weight has shown a 50% reduction in knee pain.
So while losing weight is a daunting prospect it can have a huge impact on level of pain and quality of life.

The most effective way to achieve weight reduction in this study was a combination of diet and exercise, when compared with diet or exercise changes alone.
Diet changes involved a 800-1000 kcal/day deficit and exercise consisted of 1 hour, 3 times a week and incorporated aerobic and strength training exercises. This program was continued for 18 months.

To kick start your journey Enhance Physiotherapy now offers the GLA:D Program – an exercise and education program as a first line treatment for anyone with hip and knee osteoarthritis.
To get more information contact the clinic on (02) 6041 3609

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April 2, 2019Matthew LewingtonUncategorized

If you are experiencing regular neck pain that just won’t go away, it’s possible that parts of your daily routine are contributing without you realising.

Here are a few common everyday activities that might be making your neck pain worse.

1. Your sleeping position

It’s easy to underestimate the impact your sleeping position has however, spending hours in one position will undoubtedly have an effect on your body. Pillows that are too high or too flat can mean your cervical joints are sitting at the end of their range in too much flexion or extension. Similarly, sleeping on your stomach often means your thoracic spine is locked into extension and your neck is fully rotated. In simpler terms, this means your joints are under more stress than necessary. Ideal sleeping posture allows your spine to maintain it’s natural curves.

2. Your daily commute

Many of us make sure our work stations are ergonomically set up to reduce stress and strain throughout the day. Few of us take the same consideration when it comes to driving. In fact, the set up of your car can be just as important as your work-desk, particularly if you are driving more than 30 minutes everyday. The correct setup in your car can mean you use less effort to drive and turn your head less often to check traffic. Ensuring that your steering wheel, seat and mirrors are set up correctly could make a difference to your posture and even perhaps reduce neck pain and headaches.

3. Your downtime

Many of us unwind by watching TV or using our phones or laptops at the end of the day. Your position during this time can be something you give little thought to however, looking up to view a screen mounted on a wall or looking down at a small screen or laptop can put pressure on the upper structures of the neck. Take a few minutes to consider what posture you’re sitting in before settling down to binge watch a series and see if you can either lower the height of your screen or raise it slightly so your neck can be in a more neutral position.

4. Your exercise routine

Any activity that requires sustained positions or repetitive neck movements can contribute to neck pain. Cyclists can be stuck in neck extension while looking ahead and breast stroke swimmers can also have excess neck extension. Freestyle swimmers with reduced thoracic or neck rotation can have difficulty achieving rotation when breathing which can cause pain and discomfort over time.

Your physiotherapist is able to identify any daily habits or activities that might be contributing to your neck pain. Come and see us for an appointment to see how we can help.

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