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How to Reverse Ageing, Prevent Osteoarthritis and Stay Active, Agile and Independent

Interview 008

It’s the holy grail of healthcare. How to turn back the effects of time on your body so that it doesn’t wear out and / or “groan” from the cumulative strain of a lifetime of life forces.

Imagine ageing without any associated physical pain. To contemplate such a possibility is almost absurd.

And yet, in theory and proven in real life, this possibility can become reality.


An Amazing Story About an Amazing Person

Let me explain.

May presented for treatment of her lower back pain at the age of 98. From her assessment, it was clear that May experienced back pain when she was sitting. Consequently, I recommended that May place a lumbar roll (back cushion) in the small of her back while she was sitting.

May then informed me that none of her chairs had a back on them as she only sat on stools. In other words, the cause of May’s lower back pain was the fact that she sat on stools with a slouched posture. Once corrected, her pain resolved within a couple of weeks.

It was then that I asked May “How would you like never to have to go into hospital or into a nursing home for the rest of your life?” to which May replied “Yes please”.

So we set about implementing a treatment program that would address and counter all the physical effects of ageing – the stooped posture, the specific muscle imbalance, joint stiffness, loss of balance and the faulty performance of everyday activities.

And you know what? We achieved it! Who would have thought that I would be treating May on and off for another 10 years. In that time, she never went to hospital (except for unrelated non-physical conditions) and never went to a nursing home (except for occasional respite).

Even more amazing was that May never had a hip replacement, nor a knee replacement and up until the last month of her life, she was still going out and playing bingo three times a week and catching up with her grand-children and their friends every Saturday for lunch.

What’s more, May lived at home independently at home until she passed-away surrounded by her family and friends.

It’s an incredible story about an incredible person. For me it was an absolute privilege and a great learning lesson.

Now, you might say that May had great genes and that might be the case. But, I like to think that the treatment program that we implemented also positively impacted May’s physical health so that she could stay mobile, independent and be able to perform her every day activities without limitation or pain.

Her story changed my perspective that getting old didn’t have to mean becoming disabled and dependent.

How could it be possible though to live to 108 and not need a joint replacement, let alone remain active and independent?


The Secret to Preventing, Reversing or At Least Slowing Ageing

The answer has to do with your body’s ability to heal and adapt to physical forces.

You see, your body is constantly changing with the forces being applied to it. Apply force that is within your body’s physiological limits and it will adapt positively by getting stronger, more resilient and / or more flexible. Apply forces that are outside its physiological ability to cope, it will cause breakdown of tissue. Apply no force and your body will waste away.

Your body actually lays down tissue wherever and whenever stress is applied and removes tissue whenever stress is taken away. Stress muscles, they get bigger. Remove stress from muscles, they get smaller. That is why it is often said “use it or lose it”.

The key to preventing, reversing or at least slowing osteoarthritis and the “ageing” of joints has to do with a concept called “The Path of Instantaneous Centre of Rotation”.

Many of the joints in your body are “ball and socket joints”. One end of the bone is like a ball that fits inside the hollow socket of the adjacent bone. And what “The Path of Instantaneous Centre of Rotation” means is that the axis around which the ball moves is perfectly located in the centre of the socket at any and every instant, no matter what position the joint is in or what movement your body is performing.

In this scenario, your prime mover muscles act like guidewires, pulling on your bones to move your body whilst your stabilizing muscles constant, precise tension keeps your joints in optimal alignment.

If one muscle is used more often as with performing a routine movement, it is likely to get stronger and pull earlier than the surrounding muscles. Likewise, if you stretch soft tissue for 20 minutes such as if you adopt a slouched posture, it will take at least 40 minutes for that tissue to regain its normal, pre-stretch characteristics.

Both these “adaptive” processes lead to muscle in-coordination, faulty bony alignment, joint stiffness or instability, inflammation and tissue breakdown. Once this process has begun, it is perpetuated and reinforced as these postures and movements become habits.

On the other hand, a variety of stresses such as what occurs with different postures and movement patterns, leads to ideal joint alignment and muscle balance.

Think about it this way. Imagine that your spine is the rim on a bicycle wheel and the spokes are your muscles. Pull too hard on one of the spokes and the rim is pulled out of shape. To pull the rim back into alignment, you need to tighten the loose spokes and loosen the tight ones.


How to “Reverse” Ageing

The same is true for your body. To “pull” your body back into ideal alignment, you need to tighten (strengthen) the loose muscles and loosen (stretch) the tight ones.

Likewise, your stiff joints need to be “freed up” with hands on techniques and your unstable or hypermobile (excessively mobile joints) need to be stiffened through the use of taping, bracing or by improving the control of your stabilising muscles.

Therefore, if you know the degrading effects of ageing (just have a look at the elderly people around you), then it becomes obvious what joints you need to free up (e.g. back, hips, knees and ankles), what muscles you need to strengthen (e.g. mid and lower back, gluteal and calf muscles) and what postures and movements (e.g. sitting, standing, squatting, walking) that you need to correct to reverse this process.

To reverse the ageing means to reverse this process of becoming stooped, stiff and dysfunctional. To achieve this isn’t necessarily difficult, but it does take a disciplined and graduated program of “hands on” techniques, specific muscle training and posture and functional movement correction.

No one technique or facet of treatment or training will achieve this end result by itself. It must involve a sustained, coordinated approach for at least 4 to 6 weeks.

Why? Because it takes at least 4 weeks for muscles to strengthen and for new posture and movement habits to form.


Do You Have a Software or Hardware Problem?

Having said all of this, you might be unable to achieve ideal forces on your body, simply because of the way that your body is.

You may have been born with one of many physical variations such as a long leg, a twisted spine, a bent back, a flat back, a Pidgeon chest, curved shin bones, high arched or flat feet.

In this case, you have a hardware or structural problem and no amount of treatment or training is going to absolutely correct this. Treatment and training may help bring your body back within normal limits, but it will never “perfect” your body’s\ alignment or mechanics.

For a structural problem, you need a structural solution such as an orthotic, a brace and sometimes even surgery. Although, in most cases, it is safer, cheaper, safer and more effective to start with the least invasive approach first. Surgery should be the last option when all else fails.

These structural variations may be genetic and therefore may be something that you can’t do much about.

However, in many cases, you may have a software problem. By this I mean that it may be a your core stability, body co-ordination, posture and movement habits as well as your diet, self-identity, perception and / or your way of thinking that lead to physical pain and ageing.

Left untreated for long enough and these software problems can become hardware problems as your body adapts to life forces and these adaptations become fixed.

This is why it is always better to be seen earlier rather than later and to have a complete and professional physical and functional examination to determine causes and identify sources of your pain and / or dysfunction.

How you age to a large extent is up to you. What will you choose? To stay active, independent, involved and connected or to become disabled, dependent and dysfunctional.

The choice is yours.

I hope that this helps.

If you have any questions or would like any advice, instruction or perhaps a complimentary, no obligation physical or injury assessment, please call 1 300 BODYWISE (263 994).

In the meantime, I wish you the best of health and life.

Michael Hall
Director
Bodywise Health


Please note:

Rebates are available through your private insurance extras cover;

For complex or chronic conditions, you may qualify for the CDM (Chronic Disease Management) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

References Available on Request

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2 Myths That Will Prevent Your Full Recovery

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It is amazing!  
 
Today, we have more health apps, exercise gadgets, computerised movement machines and wellness technology for every man, woman and child than at any time in human history.  
 
Instantaneously, we can know everything from how many steps we have taken, to how many kilojoules we have burned, to how we slept, to our resting and exercise heart rates.
 
We have a pill or supplement for everything, whether it be to improve our health before we were born, to increasing our libido, improving sleep, building muscle, lowering stress, you name it.
 
We have more gyms, health clubs, personal trainers, exercise physiologists, boot camps, pilates studios, dance studios, gym studios, spin clubs, sporting clubs than ever.  
 
Likewise, there are more doctors, physiotherapists, osteopaths, chiropractors, myotherapists, remedial massage therapists, acupuncturists, podiatrists, Alexander Technique therapists, Feldenkrais practitioners, dietitians/nutritionists and naturopaths per capita than ever.1 And yet, the number of people getting scans, taking pain medication and having joint replacements, PRP injections and cortisone injections has never been higher.2
 
Take note as you drive or walk around any suburb and you will find a plethora of health-care places. Anyone would think that we are the sickest, most in pain, most dysfunctional generation of people, ever.
 
What is going on? Despite these so called health advances, the incidence of physical and mental illness and injury is not improving.3
 
And if you don’t care now, you will when your healthcare and life / income protection insurance premiums, as well as your taxes (Medicare rebate) go through the roof in an attempt to cover the explosion in healthcare costs that is happening and likely to increase in the future.  
 
Possibly the two greatest untrue myths of this crisis are our quick fix mentality and our blinkered, isolationist approach to healthcare.  
 
Let’s face it, modern sports medicine would have you believe that to get better you need to get a scan, have surgery and voila, you will be better.
 
Often, we are left with the impression that tissues and structures have magically healed. And it leads to the logical conclusion that we should also expect the same miraculous cure if we get injured.  
 
Very rarely however, is there any mention of the extent of the injury, the amount of treatment (often many times each day), ongoing injections and pain medication that an athlete may be taking as well as what the long term effects of the injury might be. 
 
Implied in this myth is that pain is the enemy. Pain medications, injections and even surgery tend to give the sense that pain must be avoided at all costs. And yet, legitimate pain is an essential aspect of healing. Why? Because legitimate pain, or pain that is logical, reasonable and purposeful, changes behaviour, in a positive way that facilitates healing. In fact, there is no more potent changer of behaviour than pain. 
 
Legitimate pain is like the warning lights on your car dash-board. Like these warning lights, legitimate pain indicates that something may be wrong. With your car you know that if you keep driving you risk doing major damage to your car.  
 
However, unlike our car warning lights, when we experience pain, we often try to ignore or repress it so that we can keep going, putting us at risk of further injury. And then, we wonder why our injury hasn’t healed and / or has worsened. It just doesn’t make sense.
 
Understand that the longer that you have had your problem and the more severe that it is, then generally the longer that it may take to get better.  
 
Hence, it is probably unrealistic to expect that if you have had your pain for longer than 3 weeks or longer, that it going to be better in one or two sessions. The reason is that not only has your injury not healed, but your body, brain (neural pathways) and even the way that you live, have already begun to adapt to your injury. 
 
In addition, treatment needs to be intense enough to create and reinforce a positive change. Even if you are seen for one hour a week, there are 167 other hours where the pressures of life can so easily undo all the benefits of your treatment. 
 
This is especially true in the first couple of weeks where healing may be more “fragile” and hypersensitive to stress. Consequently, treatment initially must be more intense to protect you from re-injury and then taper as you experience a progressively longer lasting result. 
 
To achieve any result however, your active participation in your recovery is absolutely vital. Without it, it is likely that your recovery will either be delayed or impeded.
 
If you need to use pain or other medication to control inflammation or to enable you to cope and function, then please do so under the guidance of your doctor. Know that this medication is not the end result, but a means to an end in your journey to be pain and limitation free.
 
The other untrue myth relates to our blinkered, isolationist approach to healthcare.  Becoming a specialist enables a health care professional to charge a lot more money. It also gives the impression that a health professional who has “specialised” in an area of the body, must be good at what they do. After-all they are a specialist. They must know more detail about the area of the body that they have studied than a generalist who just knows a little of everything.  
 
However, the evidence is that very rarely do physical problems in your body occur in isolation. For more information, please read The Surprising Cause of Pain 
 
In fact, it is possible that every mechanical pain felt in one part of your body might be caused by a seemingly unrelated tissue or structure in another part of your body. And the danger is that a specialist health professional, knowing just one area of your body well, doesn’t consider incorrect function in other areas of the body or even in the way that you live that may have led to the pain.
 
Over the last ten years or so, there has been a revolution in our understanding of the brain’s involvement in the experience and perpetuation of pain. Whilst once the brain was thought of as a receiver of pain, now it is known that after some time the brain may become a transmitter and perhaps even a magnifier of pain. 
 
Consequently, a major thrust of treatment has focused on normalising your experience of pain by accepting and embracing legitimate physical and psychological pain as a necessary aspect of healing and recovery.
 
Now, it is understood, that it is not your muscles, nor your nerves, nor your joints, nor any one tissue or structure that may be at fault. It may actually be all of these tissues and structures and more that may be contributing to your pain or problem based upon how you move and live.
 
Preventing and recovering from physical injury isn’t necessarily difficult, but it does take work, discipline and even sacrifice.
 
Every-day, I see classic examples of the falseness of these two myths.  
 
For example, just yesterday, Sue presented complaining of left and right foot big toe pain. She informed me that a couple of years ago she had bunions and neuromas (swollen, inflamed nerves) removed from the inside of her big toe.
 
When I looked at her feet and the way that she walked, immediately I could see her problem. Despite having her bunions removed and been given orthotics, Sue’s “bunions” were returning. In addition, her big toes were pushing inwards, squashing all of her other toes.  
 
Sue walked with her feet turned out and wide apart. The two possible reasons for this are lack of balance and poor hip strength, which were then confirmed on testing. 
 
Not only is walking with your feet wide apart inefficient and tiring, it means that Sue’s body weight is falling inwards. As a consequence, Sue’s thighs tended to roll inwards causing flattening of her feet (pronation) and leading her to push off the inside of her big toes with every single step.  
 
Walking like this then leads to foot pain, ankle stiffness, calf and outside thigh tightness, weakness of her quadriceps and buttock muscles, instability of her core and osteoarthritis of her feet, ankles, knee, hips, back and even her neck. No wonder Sue was in pain!
 
Fixing Sue’s problem is not hard, but it does take work. It involves, freeing up her hips and ankles, increasing her core, hip and thigh strength, improving her standing balance and correcting the way that she walks. Orthotics would also be helpful in accelerating and sustaining her progress.  
 
The bottom line is deal with your pain, actively. Address the sources and the causes of your pain. Be pro-active and disciplined in following through with a specific treatment strategy that will deliver you the result that you want.  
 
With your therapist, develop a strategic treatment plan complete with aims, actions, milestones and a timeline. Then monitor your progress. Celebrate your improvement and make adjustments where necessary to ensure that you stay on track. 
 
The modern world has duped us all into believing that injury prevention and recovery involves some magical pill or miracle technique. It is so appealing because it doesn’t take effort, costs little and is highly convenient.
 
But these are false myths. Injuries do not occur for no apparent reason and they do not tend to occur in isolation.
 
Your aches and pains, as well as any other signs or symptoms such as swelling, clicking, tightness, grating, is your body’s way of telling you that something may not be quite right.  
 
Don’t dismiss these warning signs. Learn about them, understand them and address them quickly and comprehensively. This is the best way for you to achieve the best, fastest result possible.  
 
The real question is, “Are you willing to do the work?” no matter how inconvenient, uncomfortable or time consuming it might be.
 
Because if you are not, then just be aware that you may be wasting your money, time and your life with costly, temporary, band-aide solutions, that may in fact lead to a worsen of your problems. In the end, it may cost you and all of us a lot more than just dealing with the causes of your problem in the first place.
 
The choice is yours.
 
If you have any questions or would like advice on any signs or symptoms that you might be experiencing, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
I wish you the best of health and life.
 
Michael Hall
Director, Principal Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the CDM (Chronic Disease Management) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
 
References Available on Request
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5 Secrets to Overcoming Your Injury

 
If you are like me, you want to avoid injury. And if you do get injured, you want the best, fastest, most complete recovery possible. After all, the financial, time and life costs of not getting better can be immense, affecting adversely every aspect of your life - your physical and mental health, your relationships, your work, your home life, everything.
 
But what if you had to know just 5 critical pieces of information to get better? Recovering from injury wouldn’t be such a mystery. Suddenly, getting better may become less costly, less time consuming and less frustrating.
 
These 5 critical pieces of information form the basis upon which we, physiotherapists decide the treatment strategies which are most likely to give you the best, fastest healthcare outcomes.  
 
These pieces of information are the sign-posts which direct what treatment modalities and techniques we use, when we use them and how we use them, to ensure that you experience the best results.  
 
If followed, these secrets virtually ensure that you will get better no matter what. To find out what they are, please read on.
 
 
Secret Number 1 – Where Is Your Pain or Physical Problem?
 
I say “pain” because this is almost always these reason why people attend for healthcare. They have a pain which stops them from doing something that they love to do.  
 
However, your physical problem might also be one of weakness, stiffness, tightness, clicking, grating or the feeling of instability. All of these signs and symptoms are legitimate reasons to seek professional treatment, especially if they are not going away and / or are worsening.
 
Where you have your problem is a key question because it enables you to hypothesise as to what tissues and structures might be the possible source(s) of your pain. 
 
In other words, answering the “where” question helps you to answer the “what” question.
 
Asking the “Where” question also helps you to explore other possible associated pain or problem areas.  
 
Do you have some discomfort in your neck or back even though your main concern is pain radiating down your arm or leg?  
 
Is there a relationship between signs and symptoms in what seem to be unrelated areas of your body? To read more on this, please click The surprising cause of your pain. 
 
 
Secret Number 2 – How Did Your Pain or Physical Problem Start?
 
It is really important to know how your signs and symptoms have started.  
 
Was there a trauma where you hit or were hit by something such as in a car accident or in a fall to the ground?
 
Was it a specific movement or activity that you felt something “go” such as when you swung a golf club or got out of the car?  
 
Or did your signs and symptoms come on for “no apparent reason”. You may have a vague idea of when, but you can’t remember exactly how your signs and symptoms started.  
 
If you suffered a trauma, where there was some kind of external force that caused your injury, then almost always it is a good idea to have an x-ray or scan to check the extent of the damage. This is because it is really difficult to quantify the forces involved. What might seem to be the most minor force can cause extensive damage.
 
If there was a specific activity or movement that caused your injury, this gives an indication as to the amount and direction of forces that were involved, the structures or tissues that might be injured and the extent to which they might be damaged. 
 
When your injury is examined, these structures are then stress tested to determine if they are indeed damaged and by how much.  
 
The direction of injuring force is also important as this indicates what further forces are likely to re-injure that structure or assist in healing.  
 
If you can’t remember when or how your signs and symptoms came on, then we need to do some “detective work”.  
 
Generally, signs and symptoms that start for no apparent reason indicate that there may be something “wrong” in the way that you are living that is the cause of your physical problem.  
 
It is often difficult to identify the causes of a pain, because often it is not so much what you do which is the culprit, but how you do it. How you stand. How you sit. How you get out of a chair. How you walk. How you…do anything, is unique to you. 
 
Your brain and your body then adapts to these repeated postures and movement patterns. Nerve pathways are reinforced. Muscles that are used more get stronger. Joints that are moved more, get more mobile. Joints that are used less get stiffer. And all these body changes not only perpetuate your physical habits, they actually make them stronger and more likely to happen again.
 
Doing a slightly “faulty” automatic posture or movement occasionally might not cause any issues. But doing them daily, weekly, monthly, yearly, will eventually cause you a physical problem, guaranteed.
 
Ultimately, how your signs and symptoms have come on hints at whether your problem is mechanical, inflammatory or insidious. In other words, is your problem generated from your interaction with the external forces of the world or are they generated internally.  
 
Is in fact your brain, nervous system, immune system and / or other body processes generating the pain as in the case of Rheumatoid Arthritis, Osteoporosis or Cancer? Yes, physios do screen for cancer.
 
 
Secret Number 3 – When Did Your Pain or Physical Problem Start?
 
If knowing where your pain is gives clues as to what structures might be the source of your problem and how your injury started gives clues as to the cause of your injury, then knowing when your injury started can give clues as your injury’s current phase of healing as well as the amount of repair that may have already taken place. 
 
For example, whilst there is some overlap and variability as to the different phases of healing, a general timeline might be:
  1. Bleeding Phase: 6 to 8 hours and up to 24 hours or beyond
  2. Inflammatory Phase: The first day or two post injury through to its peak at 2-3 weeks and decreases thereafter through to a matter of several months post trauma.
  3. Remodelling or Maturation Phase: Recent evidence indicates that the remodelling phase may start at around 1-2 weeks and may last up to 2 years.
 
Factors that affect your healing rate include:
  1. The type of tissue involved (muscle faster than ligament faster than tendon)
  2. The injury severity (Grade 1 faster than Grade 3 injuries)
  3. Your age (younger = generally faster healing)
  4. Your general health (e.g. diabetes results in compromised healing)
  5. Your nutritional status (e.g. inadequate protein intake)
  6. Your stress levels (greater stress = slower healing)
  7. The medication you take (anti-inflammatories delay healing)
  8. Whether you smoke (smoking impedes healing)
 
Knowing the phase of healing and the healing rate of the different types of tissue, also directs the type of intervention that need to be given to achieve optimal healing.  
 
For example, during the bleeding phase, Rest, Ice, Compression and Elevation is indicated to limit bleeding and excessive swelling.
 
During the inflammatory phase gentle movement in elevation may be indicated to facilitate waste product removal and facilitate the delivery of oxygen and nutrients to the repair
 
 
Secret Number 4 – What is the Behaviour and Irritability of Your Physical Problem?
 
Physiotherapists also want to know if your pain or problem is getting better, same or worse.  
 
As your body’s natural state is to heal, if your problem is not getting better, we need to find out why. 
 
Are you re-aggravating (re-injuring) your problem?  
Is inflammation breaking down the healing tissue and if so why?  
Are any of the above factors impeding your healing response?
What other factors might be acting as roadblocks to your healing and how can you remove them?
 
If your injury is worsening, you need to see a health professional immediately to have it assessed and get remedial intervention.
 
Physiotherapists also use a concept called Irritability to determine how assertively techniques should be applied to achieve the best and most long lasting effect from each treatment. 
 
This concept refers to the amount of pain caused (on a 1 to 10 scale, 0/10 = no pain, 10/10 being the worst pain you could imagine), and how long it lasts with regard to the intensity and duration of the force that caused the response in the first place.
 
For example, if you gardened for 8 hours and following experienced 15 minutes of back discomfort at a pain level of 2/10, we would say that your injury is not irritable. This would be an indicator that more assertive treatment is unlikely to lead to a flare-up.
 However, if you bent over to pull up a weed and then experienced 10/10 pain which lasted for two days, this would indicate that your condition is highly irritable and as therapists we would need to be very careful and gentle in out treatment intervention.
 
 
Secret Number 5 – What Postures, Movements or Activities Aggravate Your Pain?
 
Along with knowing how your pain or problem started, knowing the factors that aggravate and ease your pain tends to indicate why your condition started and the direction of force that will both help and or hurt you. Obviously, you want to do more of what helps and avoid what hurts your injury to enable your condition to heal.
 
Applying too much force too soon (including exercising too hard) will re-injure your injury.  
Judging when and how much force to apply to optimise tissue repair takes great knowledge, experience and skill. Even then, it is easy to get wrong.  
What you need to know is that at 1 month of healing, the tensile strength of collagen is around 40% of its original pre-injury strength and at 1 year it reaches 70%. The absence of pain is therefore no indication that your injury is 100% better. It can take years.
 
Knowing where your pain or problem gives clues as to what the possible sources of your pain or problem.
 
Knowing how your problem started gives clues at why your pain or problem has started.
 
Knowing when your problem started gives clues as to how long it may take for your injury to get better.
 
Knowing the behaviour and irritability of your problem gives clues as to what and how much intervention can be applied.
 
Knowing what factors aggravate or ease your pain, gives clues at the direction of forces that need to applied to facilitate healing and prevent re-injury.  
 
Please note that whilst this information gives the principles of treatment, it is general in nature and does not address your personal, unique circumstances. If you do have any questions or concerns, please seek individual advice and get be assessed and examined by a qualified health professional.
 
At Bodywise Health, we have treated over 14,000 people and delivered over 100,000 treatments over 21 years. We would be delighted to help you overcome any pain or physical problem that may be holding you back from getting the most out of life.
 
For a complimentary assessment, advice and a personalised strategic treatment plan to get you better, please call 1 300 BODYWISE (263 994). 
 
Wishing you the best of health and life.
 
Michael Hall
Director, Principal Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the CDM (Chronic Disease Management) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
 
References available on request

 

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Why You Need More than a Diagnosis To Get Better

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It has been said that “Treatment without diagnosis is malpractice”.

And it is true that in todays’ practice of modern healthcare, diagnosis provides the over-riding foundation which directs both the type, amount and sequencing of treatment interventions.

Our obsession with diagnosis is evidenced by the explosion of diagnostic tests that are performed every year.

However, not only can the increase in CT and X-ray scans pose a health risk, they can be misleading. Consequently the surge in CT and MRI scans has failed to boost diagnostic rates.

And yet, even if CT, MRI and ultrasound scans did increase the accuracy of your diagnosis, this may not be enough to improve treatment outcomes.

The reason is because while x-rays and scans might tell you what the source of your problem, they do not tell you the cause. In other words, they give you the what, but not the why.

And although it is important to know which structure or tissue is the origin of your pain or problem, it is perhaps more important to know why. Because unless the cause of your ailment is corrected, your problem will always return even if you replace the injured body part.

I spoke about this phenomenon in my blog The Surprising Cause of Pain. In modern healthcare, we strive to name your diagnosis. That by putting a label on your condition, we can somehow better encapsulate, understand and manage your ailment. However, in so doing, we risk becoming blinkered to other possible sources, causes and implications of your injury.

Being given a diagnosis often gives the impression that it is just one tissue, one structure or one body part that is at fault, when in reality, it is often many tissues, structures and body parts that contribute to the cause of your physical problem.

A case in point is osteoarthritis. Osteoarthritis refers to inflammation and the subsequent breakdown of the surface covering of the bone ends at joints. What perhaps is not so well known is that along with this, the underlying bone begins to breakdown.

Bony projections (called osteophytes) form at the joint margins.

The membrane lining the inner part of the joint (synovial membrane) becomes inflamed and swollen causing excessive fluid to be secreted.

Joints become red and swollen.

The capsule and ligaments that hold joints together may become lax.

Muscles either spasm or become flaccid causing muscle imbalance and joint mal-alignment.

Nerves become hypersensitive and restricted.

Connective tissue (fascia) becomes taut and fibrotic.

Blood flow may be compromised.

The surrounding environment may become acidic.

Even your brain can become stressed, sensitized, reactive and magnifier of your pain.

And so the cycle of chronic pain begins and is perpetuated.

And this is not even to mention the incorrect motion in other parts of the body which may have led to the abnormal or excessive forces that caused the osteoarthritis in the first place.

The same goes for any injury whether it be a muscle strain, a joint sprain, disc injury, tendinopathy, bursitis or other condition.

I had a classic case of this a couple of weeks ago. Ann was suffering with intense inside right knee pain that came on “for no apparent reason” a couple of weeks before. So painful was Ann’s knee that I had to see her at home because she was unable to put weight on her right leg to walk.

Ann reported that she had had an MRI which revealed a burst Baker’s cyst (fluid filled sack behind the knee). This finding didn’t match Ann’s knee pain as a burst cyst would generally lead to pain, tightness and swelling behind the knee and Ann’s pain was on the inside just below the knee joint.

On examination, Ann’s right knee was indeed red, swollen and exquisitely tender on the inside of the knee just below the joint line. This corresponded to a different inflamed bursa (fluid filled sack called the Pes Anserine Bursa).

After applying cold packs and teaching Ann how to use crutches so that she didn’t weight bear on her right leg, Ann left to have another MRI for confirmation. This MRI revealed that she had a torn inside cartilage and this was the diagnosis that was given to Ann as a cause of her pain.

So Ann then underwent an arthroscope to “repair” this inside cartilage. To my surprise however, Ann returned to me two weeks later. Despite having an arthroscope, Ann’s pain hadn’t changed. In effect, the arthroscope may have corrected a condition, but this condition wasn’t the source of Ann’s pain.

On retrospect, I shouldn’t have been surprised, as again the MRI didn’t match Ann’s signs and symptoms; that of redness, swelling and intense pain just below the joint line on the inside of Ann’s knee over the area of this bursa.

Furthermore, on close questioning, it became clear that Ann’s knee pain was being caused by the way that she was sitting. So Ann was put on intense program to treat the inflamed joint tissues (synovium), fascia (connective tissue) nerves, muscles and bone surfaces. Ann was also shown how to sit and walk without aggravating her knee.

Two weeks later Ann left for overseas with minimal pain.

For the best, fastest, most complete recovery, it is essential that all the implications, complications and contributions to your ailment are adequately addressed, treated and resolved.

This is referred to as the Bio-Psycho-Social Model of Healthcare. It refers to the fact that the best outcomes will be achieved only when all the Biological, Psychological and Social factors have been taken into account and solved.

For optimal healing and recovery you must treat the muscle, the joint, the connective tissue and the nervous system.

You must correct the biomechanics, posture and movement patterns.

You must optimise the psychological and social environment to enhance recovery.

Yes, a diagnosis is important. But even more important is that the “diagnosis” given from an investigation such as an x-ray or scan is confirmed by a comprehensive assessment and professional clinical examination.

It is then critical, that all the information gained is used to devise a treatment strategy or Recovery Action Plan that treats and corrects both the source and cause of your problem.

This is the only way to achieve the best, fastest, most complete recovery possible.

If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994).

We would love to help you get back to living freely and without pain.

Wishing you the best of health and life.

Michael Hall
Physiotherapist
Director, Bodywise Health


For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).

Please note:
· Rebates are available through your private insurance extras cover;
· For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).

References available on request

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364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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