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What to do if you get injured

Knee RICE

By Michael Hall

There is no doubt that your treatment in the immediate 24 hours following an injury has the biggest impact on how long and how well it may take you to recover from an injury. Weeks and sometimes months can be saved from your recovery time if you receive optimal, acute injury management. So, if you want to achieve the best outcome, it is critical that you get this initial management right.  The following is a guide on how to get the best results.

The Bleeding Phase - Perhaps the MOST Important Phase of Healing

“The most important time in the treatment of acute soft tissue injuries is in the 24 hours immediately following injury”.1

When you injure soft tissues, the blood vessels are also often damaged. Blood then pools around the injured tissues causing swelling which stops oxygen exchange, leading to further tissue damage. This bleeding phase may last from just a couple of hours for less vascular tissues such as ligaments up to 24 hours from crush injuries (corked) to muscle.

Consequently, the most important thing that you can do at this stage is to reduce bleeding and swelling at the site of injury. The best way to do this is summarised in the letters PRICER and HARM:

Protection

Ice

Compression

Elevation

Referral

Protection

Protection of the painful or injured body part is essential to prevent re-injury. This can be best achieved through unloading or at least partially immobilizing the injured area through the use of taping, braces, slings, cam walkers and crutches. Even supporting your injured arm with the uninjured arm can work. Part of the value of using these aids is that not only will they stop you from aggravating your own injury, but they will also alert others to the fact that you are injured and therefore need to take care around you.

Rest

Following injury, you should cease activity to limit bleeding and swelling to reduce the size of the scar in injured soft tissue.2

Ice

Ice or cold treatment is used to slow cellular activity.3 It has been proven to reduce bleeding, inflammation and tissue death as well as accelerate early muscle regeneration.2,4,5 It has been our experience at Bodywise Health, that most people don’t achieve optimal results because the ice/cold pack are not cold enough.

For best results, place an ice or frozen gel pack in a damp tea towel and strap it in place with moderate compression. Check your skin every five minutes to ensure that there are no adverse reactions such as whiteness or crispiness of the skin. Remove the cold pack immediately if this occurs.

The most effective method for reducing pain immediately following an injury (ankle sprain) has been found with Intermittent ice (cold) application.6 This involves 10 minutes of ice, 10 minutes of rest and then 10 minutes of ice every two hours over the initial 24 to 48 hours.

More usually ice is applied for 20 minutes continuously every two hours for at least six hours following injury. 4,6,7

At Bodywise Health however, we have achieved faster recoveries and better results with applying ice for 15 minutes every one to two hours for two to five days or at least until the severe pain and inflammation (signs-heat, redness, swelling) have settled down.

Please note, ice should not be applied if you have impaired circulation or if you suffer from an allergy to cold. In addition, you must take care when applying ice as prolonged applications can cause ice burns and nerve damage.8

Compression

Compression not only supports injured tissue, it also reduces bleeding, swelling and scarring and aids healing by improving circulation. It should be applied during and after ice application from the time of injury for perhaps up to two to three weeks post injury. The compression bandage must be firm but comfortable and begun a hands breadth below the injury extending to a hands breath above the injury with each layer overlapping the previous layer by one half.

Elevation

Lifting (elevating) your injury above your heart is also minimizes bleeding and swelling.2 Elevating arm injuries is best achieved by using a sling or even the opposite arm. Likewise, leg injuries should be elevated above the pelvis by lying down and using a chair, pillow or bucket to raise the leg.

Referral

The greatest impact for limiting tissue damage and optimizing injury outcomes lies in the first three to five days following an injury. At Bodywise Health, we have found that the sooner we can assess and effectively treat an injury (i.e. same and / or next day), the better the repair, the faster the recovery and the better the outcome that people achieve, without exception.

In the first 72 hours after being injured, you must also avoid HARM-ful factors. These include:

Heat packs, heat rubs and hot baths (showers) as these will increase bleeding, swelling, tissue destruction and inflammation at the injured site.

Alcohol as it may mask pain, reduce muscle function and impede recovery.9

Running/moderate activity will cause further damage.

Massage/vigorous soft tissue therapy as this will also cause further swelling and bleeding.

There is no doubt that immediate, effective treatment is the best way for you to limit the financial, time, stress and opportunity cost of an injury. So if you want to save money, if you want to save time and if you want to get your life back as quickly as possible, make the most of this time. It could save you weeks and months of treatment.

If you are injured and would like to know what is the best and fastest way to get better, please call 1 300 BODYWISE (263 994) for your FREE assessment and advice.

I hope that this helps.

Kind regards,

Michael Hall

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).

Further information and advice can be accessed through:

  1. Sports Medicine Australia at http://sma.org.au 
  2. The Australian Pain Management Association at http://www.painmanagement.org.au
  3. The Australian Physiotherapy Association at www.physiotherapy.asn.au/DocumentsFolder/Advocacy_Position_Pain_Management_2012.pdf
  4. Arthritis Australia at http://www.arthritisaustralia.com.au
  5. The Victorian Arthritis Association at http://www.arthritisvic.org.au

References

  1. Brukner and Khan and Colleagues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.
  2. Jarvinen TAH, Jarvinen TLN, et al. Muscle Injuries: optimizing recovery. Best Prac Res Clinis Rheumatol 2007;21(2):317-31.
  3. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft tissue injury. Am J Sports Med 2004;3(1)251-61.
  4. Bleakley CM, O’Connor S, Tully MA et al. The PRICE study (Protection, Rest, Ice, Elevation): design of a randomized controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain(ISRCTN13903946) BMC 2005;33(5).745-64
  5. Jarvinen TAH, Jarvinen TLN, et al. Muscle Injuries biology and treatment. Am J Sports Med 2005;33(5)745-64.
  6. Bleakley C, McDonough S, MacAuley D. Crotherapy for acute ankle sprains: a randomized control study of two different icing protocols. Br J Sports Med 2006;40(8):700-5
  7. MacAuley D. Ice therapy: how good is the evidence? Int J Sports Med 2001;22(5):379-84
  8. Moeller JL, Monroe J, McKeag D. Cryotherapy-induced common peroneal nerve palsy. Clin J Sport Med 1997;7(3):212-16
  9. Suter PM, Schultz Y. The effect of exercise, alcohol or both combined on health and physical performance. Int J Obes 2008;32(S6):S48-52.
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Probably THE most important factor in reducing your mechanical pain

Posture Pain

Gravity is the enemy. Have a look around you and you will see its force. People stooped, heads forward, rounded shoulders and curved backs.

Now think about the tasks that you do every day. You sleep, you sit, you cycle, you drive, you work at a computer, you cook, you clean, you do almost everything in a bent forward position. You may even stand and walk in a slightly forward leaning position.

Is it no wonder then that if you look at people who are in pain or old, that they are stuck there?

Your posture is one of the most important factors in determining not just your physical health, but also how well you feel, how young you look and how well you are able to perform every-day tasks.

Poor posture is related to tension headaches, upper and lower back pain, shoulder pain, hip pain, knee pain, foot pain, myofascial pain, you name it. It is also associated with depression and responsible for the forward stooped appearance that we see in so many elderly people.

With such far reaching consequences, fixing your posture is one of the quickest and easiest ways of not just helping you recover from physical pain, but of avoiding and preventing it in the first place.

What is posture and in particular, what is good posture?

Posture “refers to the relative arrangement of segments of the body” (Norkin & Levangie 1983). Ideal posture may be defined as “that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity”. Under such conditions, your “muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs.” (Posture Comm of Am Academy of Orthopaedic Surgeons 1947.)


Categories of Posture
As mentioned, posture may also be divided into two categories: static and dynamic posture. Static posture refers to the arrangement or alignment of the body parts whilst the body is at rest, whilst dynamic posture refers to this alignment during movement.

Static posture will therefore directly affect dynamic posture or in other words, the starting position for any movement must affect the precise alignment of the parts during that movement. By definition therefore, good static posture is a prerequisite for good dynamic posture as precise maintenance of correct alignment during movement cannot occur, if the body parts are not correctly aligned in the first place.

But why is posture important?
Posture is important because:

1. It determines the amount of stress on the different tissues and systems of the body which directly relates to the development of pain syndromes and injuries, and also,

2. It determines effectiveness and efficiency of movement and therefore the influences the performance levels of all physical tasks.

Essentially, good posture thereby minimises the abnormal or excessive stresses on the body and optimises the performance of all physical tasks.

2 Postural Patterns in Life
You have 2 postural patterns in life.Posture photo

1. A bending, turning inward pattern. Have a look at people who stoop (e.g. image on the left). The head is forward, the chest is depressed, the shoulders  are rounded, the upper back curvature is increased and hips are bent and the person looks old and stooped.

2. A straightening, turning outward and opening up of your body. In contrast with the image on the left, the person on the right is upright. They look tall. Their head is in line with their shoulders, their chest is lifted and their back has a normal S shaped curve.

Typical Faulty Postures and Related Pain Syndromes
If good posture minimizes excessive or abnormal forces, poor posture exacerbates abnormal or excessive stresses leading to many and varied physical conditions. Some of these include:

Head forward posture (ear lobe in front of shoulder)
- Headaches
- Neck pain (due to disc bulges, facet joint irritation)
- Osteoarthritis of the neck
- Vertebral artery signs such as dizziness, blurring of vision and ringing in the ears

Rounded shoulders and increased mid back curve
- Thoracic spine and rib pain
- Upper back muscle strains
- Shoulder pain
- Decreased rib expansion and therefore limited breathing

Flat back posture
- Low back pain with sitting, bending etc.

Increased low back inward curve
- Low back pain with walking, standing etc.

Turning in and Bent Hips
- Hip osteoarthritis
- Buttock pain (Gluteus Medius Tendinopathy; Trochanteric Bursitis)
- Knee pain (Knee cap pain, Knee arthritis)
- Ankle pain (sprains)
- Foot pain (Plantar Fascitis)

What is good posture and how is it assessed?
The standard way for postural alignment to be assessed is by using the plumb line test where the alignment of the body in standing is assessed in relation to a plumb line positioned above the body (Muscle Testing and Function by Kendall and Kendall).

From the side, a plumb line placed just in front of the outside ankle bone should pass through:
- ear lobe
- bodies of the cervical vertebrae
- tip of the shoulder
- divide the chest in half
- bodies of the lumbar vertebrae
- slightly behind the hip joint
- slightly in front of the knee joint
- slightly in front of the outside ankle bone (lateral malleolus)

From the front, the plumb line should divide the body into two symmetrical halves. The head, shoulders and hips should be level, and also the hip, knee and ankle joints should be equidistant from the line of gravity.

A caveat to this, is that Kendall and Kendall in Muscle Testing and Function state that it is normal for a person’s for the dominant side shoulder to be lower and for the dominant side hip to be higher. Consequently, for this to occur, a scoliosis must be present. They state that the reason for this is due to the increased muscle bulk and the asymmetry of limb usage of one side compared to the other.

Can you do anything to improve your posture?
Absolutely! First and foremost, before deciding whether any intervention is necessary let alone whether it is going to be of benefit, an accurate and comprehensive evaluation must be performed. This obviously will involve an assessment of postural alignment, but also it must take in account other factors such as the habitual postures and movements, as well as an assessment of muscle bulk, tightness and strength, joint mobility, balance and coordination.

Posture Pro – A great tool for assessing posture and bodily stress.posture-pro2
At Bodywise Health, our computerized posture assessment tool called Posture Pro not only gives you an accurate, objective measure of your posture, but it also is able to calculate the stresses on your neck, back, shoulders and legs, and whether they are abnormal or not.

It is a great predictor of whether you will suffer from an injury or pain in any of these areas. Reducing, stopping and preventing your pain often then goes hand in hand with correcting your posture.

Correcting your posture may involve more than just sitting and standing up straight
Correcting your posture and the abnormal stresses involved is a simple matter of using “hands on” techniques to loosen specific stiff joints and tight muscles, whilst using precise strengthening exercises to “shorten” lengthened, weak muscles. In effect, your muscles are used like guywires as the exercises effect is to muscle bind you back into better alignment.

Once gained, this new mobility and strength can then be incorporated with better awareness (reinforced with postural taping), to ensure that correct posture becomes a habit which is maintained over time.

Quick tips on improving your static posture
In the meantime, some quick tips for immediately improving your posture include:
1. Stand “tall”, lifting from the top of your head and from the middle of your chest;
2. Sit with a lumbar roll cushion in the small of your back and relax backward;
3. Strengthen the muscles that hold you up against gravity.

Quick tips on improving your dynamic posture
1. Learn to squat on each foot, keeping your knee over your second toe and without holding on;
2. Progress this to stepping down a step keeping your knee over your second toe;
3. Progress this to hopping, running and cycling keeping your knee over your second toe;
4. Run in a slightly bent forward position.

These posture improvement strategies will have the effect of lengthening your spine and stopping your body from “giving way” under the long term ageing effect of gravity.

Correcting your posture in this way is one of the quickest and best ways that you can permanently reduce your pain and improve your health. I hope that this helps.

Until then,

Best wishes,

Michael Hall
Director
Bodywise Health

For more information on how Bodywise Health can help you to improve your posture so that you may prevent chronic neck and back 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).

 

 

 

 

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How to Prevent Injury and Perform at Your Best

Running Image

I was at the Ironman Triathlon over the weekend and whilst I have great admiration for each competitor’s drive and self-discipline, I was amazed at how many people had terrible posture and poor movement patterns. Many of the cyclists had excessive curvature of their back, inadequate hip bending and their knees were turned inwards close to the bar. Many of the runners also were hunched over, with excessive turning in of their knees and turning out of their feet.

Injuries waiting to happen

In effect, all these people are just injuries waiting to happen. Why? Because the one thing that most determines if you will suffer from a physical injury is your technique. Your technique for swimming, your technique for cycling, your technique for running, walking, standing, sitting, everything.

The way to know if your pain is due to a posture or movement habit

These are the sorts of pains and physical problems that come on for no apparent reason. They just seem to appear and you can’t quite put your finger on it as to why. Any physical problem that has come on out of the “blue”, is likely to be due to a faulty posture or movement habit.

You see, it is not often what you do but how you do it that will cause you pain and problems. Poor technique doesn’t just lead to poor performance, it leads to injury as the excessive or abnormal stresses generated cause cellular irritation, inflammation, pain and tissue breakdown.

The problem for you is that many of these techniques are habits, ingrained in you from the day you were born. Most of the time you don’t even know that you are doing them.

Think about it. Many people have devices which record how many steps they take, with the target being 10,000 steps a day. How many times do you move your head, bend over, cross your legs, lean forward, sit down and stand up? Thousands upon thousands of times. And how long do you spend looking at computer screens, TV screens and smart phones? Potentially, hours upon hours.

What you may not realise is that many of the positions and movements you do each day, you do every day, in the same way, at the same speeds, in the same directions. These are called habits and you have been doing then since the day dot. They are part of your very fibre, bound up in the very way that you perceive yourself and the world around you. They are also as unique to you as your voice and fingerprints.

Poor habits = Poor health, Good habits = Good health

Now, can you imagine if you do each of these activities in a slightly “faulty” way. Perhaps you sit at a computer leaning forward, or turn your head to look at the computer screen which is off to one side. Perhaps people approach you from one side or you find yourself twisting one particular way time and time again.

If you are a gardener, builder or cyclist, it has been proven that you will finish up with a flattened lower back (Claus 1996). In other words, your body will adapt to your daily activities, much the same way that an athlete’s body will adapt to their training program. In effect, your body will reflect not just what you do, but more importantly how you do things.

Magill and associates (1992) showed that if you stretch a soft tissue (e.g. sit slouched) for 20 minutes that it takes longer than 40 minutes for full recovery. And yet, we may hold certain, “stretched” positions for hours (e.g. gardening), over-stretching tissues and never letting them recover. Is it no wonder that these tissues develop over stretch weakness that may then lead to over-stretch strain (tearing of fibres)?

Your body will follow the path of least resistance. This means that the muscles that you use more will get stronger, whilst those that you move less will get weaker.  Its the same for joints, as those that you move most will get more mobile, whilst those that you move less will get stiffer.  This reinforces and perpetuates the joint mal-alignment and muscle imbalance.  It also causes compensation to occur, often at the least desirable joint, in the least desirable direction, leading to pain and dysfunction.

“Hands- on” treatment techniques whether they be from a physiotherapist, chiropractor, osteopath, massage therapist, acupuncturist, are essential as they "loosen up" specific stiff joints and tight muscles.  However, "hands on" techniques will generally give just short term relief as they generate just short term changes in joint mobility and soft tissue tension, thereby alleviating symptoms for the time until the tissues become irritated again. Likewise, corrective exercise alone will generally give just medium term relief as while they may correct muscle imbalance, they won't correct the posture or movement which is causing the actual problem. To achieve long term, sustained relief, you must correct the posture, movement or activity which is causing the problem. 

How to fix these problems for good

To turn these problems around, the first thing you need to do is become aware. Listen to your body. How does it feel as you do or just after doing a particular activity? Does it feel abnormally tight, stiff, tender or achy? Does it grate, lock, click or give way? All these are signs that an activity may be doing you harm and are often a precursor to symptoms. These signs are to be distinguished from normal exercise muscle soreness which should last about 24 hours and indicates that your soft tissues are adapting to the exercise “stress”. Pain longer than this, probably means that you have exercised too hard and / or have sustained some sort of tissue damage.

So what is good technique?

Good technique refers to the optimal alignment and function of all the body systems, structures and tissues so that the highest level of performance is achieved and a person’s physical, psychological and spiritual health is enhanced.

5 Tips for achieving good technique

  1. Listen to and work with your body. Become aware of what feels good and what doesn’t feel good. Use mirrors or other biofeedback tools to check your form and stop the activity when you notice that your technique has become “faulty”. Make adjustments and then test to assess what works and what doesn’t work. Then keep doing what works and refine the process through practicing to improve everything that you do.
  2. Become informed by reading books, blogs and articles. Watch films that educate you in how to perform better. Attend seminars or join groups that have the same values, goals and interests.
  3. Get an assessment. You don’t know what you don’t know. In other words, you may have no idea that the way that you are doing something is potentially causing your body and health damage, let alone detracting from your performance and results.
  4. Get a coach. Whether it be by yourself or with a group, a qualified coach who is knowledgeable, competent and has a track record of results will be able to help you avoid technique and training mistakes that may lead to injury.
  5. Use equipment and training techniques that enhance your health and performance.

Your technique determines everything. Poor technique pretty much will guarantee you injury. Good technique will not only minimize your chances of suffering from an injury, but also means that you may swim better, cycle faster and run easier. So not only will you spend less time on the injury sidelines, you will have more fun doing what you love.

I hope that this helps.

Next week, I will share some quick and easy tips on how you avoid the most common injuries and / or if you are injured, how to recover faster from them.

Until then,

Best wishes,

Michael Hall

If you are concerned about your physical and nutritional health and would like to reduce or prevent pain, please call Bodywise Health on 1 300 (BODYWISE) 263 994 to book your FREE Physical or Nutritional assessment.

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).

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The Real Cause of Most Pain Syndromes and How to Prevent Them

back-pain-mainBy Michael Hall, 

With health statistics on so many fronts screaming crisis, it is no wonder why so many people throw up their hands and say that it is all too hard. Key findings from the First Results 2011-12 Australian Health Survey reveal that of the national health priority areas, the top long term health conditions experienced in Australia were:

  1. Arthritis – 3.3 million people (14.8%)
  2. Mental and behavioural conditions – 3.0 million people (13.6%)
  3. Asthma – 2.3 million people (10.2%)
  4. Heart Disease – 1.0 million people (4.7%)1

The prevalence of overweight and obese people over 18 has risen from 56.3% in 1995 to 61.2% in 2007-08 to 63.4% in 2011-12. This is of grave concern as obesity is linked with inflammation as fat cells (adipocytes) release inflammatory signalling molecules (adipokines)2. The result, obese adults are five times more likely to have high triglycerides (a predisposition to cardiovascular disease), seven times more likely to have diabetes and four times more likely to display signs of liver disease than normal weight adults.

Since the mapping of the human genome, there has been increasing hope that advances in genetic treatments may offer the greatest potential to our overcoming many of these chronic illnesses and pain syndromes. And with so much publicity being focused on genetic research as being the solution to our health problems, there may be tendency to think that we are just a product of our genes and that there is nothing that we can do to avoid the illnesses or injuries that afflicted our ancestors.

Yet, studies of identical twins have revealed that though people may have identical genes, the injuries and illnesses they experience may not necessarily be the same. How can this be if people have the same genetic profile? There must be other factors and control levers at play that influence the expression of genes. Research is beginning to uncover that the expression of genetic traits is due to complex, multitude of factors one of which is not only a person’s environment but the way that they perceive and interpret their environment. This means that people can and do have the possibility of influencing their health for better or for worse.

Intimately associated with our perception of our environment is our brain and body’s relaxation or healing response or our “fight or flight” response. In an environment of safety, love, nurturing and appropriate challenge, freedom and confidence predominate, which leads to better relaxation, sleep, digestion, growth, repair and expansion of our physical, mental and spiritual capacities. It is an anabolic or building up process of our minds, bodies and life.

With the “fight or flight” response, fear is the predominant emotion, as blood is shunted away from our gut to the muscles so that we can fight or flee. In addition, our immune system is mobilised to prepare us for injury. This process is called inflammation. The purpose of the immune system is to defend the body against attack by foreign bodies (e.g. viruses or bacteria) or act like a demolition company to clear a site of damaged tissue and debris so that new tissue can be laid down. In other words, it is a catabolic or breaking down response. Whilst this response is important in the short term for survival and healing, over the long term, a hyperactive, dysfunctional immune system will wreak havoc on our ability to stay healthy as normal tissue is “attacked” and our bodies become at war with themselves.

The characteristics of inflammation are constant often throbbing pain as well as heat, redness, swelling and night pain with the classic example of an inflammatory reaction being a mosquito bite. This in effect is the basis for most pain.

The stimuli which can lead to an inflammatory reaction can be grouped into three categories, those of:

  1. Mechanical stimuli
  2. Nutritional stimuli and;
  3. Psychological stimuli.

However, all of these categories have one thing in common; the applied stimuli which leads to inflammation is either excessive or abnormal and therefore beyond the body’s physiological ability to adapt.

There are four factors which dictate whether a stimulus might be excessive. These are:

  1. The intensity of the stimulus;
  2. The number of times the stimulus is applied (or volume);
  3. The duration of the stimulus;
  4. The recovery time between stimuli.

If any one of these variables by themselves or combined present a force that is over a tipping point, then an inflammatory reaction and pain will occur. The purpose of pain is to alert us to the need to change or stop the behaviour so that we can avoid further risk of injury. Taking away the pain with a pain killer may be doing us more harm than good as it is taking away the very mechanism that protects us from further danger.

The reason most people don’t get better is not because their body can’t heal, but because they keep aggravating their “injury”. Stop them from aggravating their “injury” and generally their problem will heal and their pain will reduce. Unfortunately, this is often easier said than done particularly in a society where we are progressively becoming less in tune with our body’s needs and “masking” or band-aiding issues is promoted ahead of dealing and working through problems.

Still, whether they be physical, nutritional or psychological stressors, if you can identify what the excessive or abnormal forces are and you are able to reduce these to within normal physiological limits, then you may be able to achieve a permanent reduction in your pain. The three areas of life in which you can do this include:

Biomechanical / Physical Pain
What differentiates mechanical pain from biochemical pain, is that it is related to certain body postures, positions or movements. Change your posture, position and / or movement and you will change your pain response.  This is in contrast to biochemical pain which is often constant, throbbing and unrelated to any movement or position.

Fixing mechanical pain is often relatively easy if the postural and movement patterns which cause and alleviate pain are consistent. Once the aggravating activities are identified, then eliminating inflammation and pain is simply a matter of changing the way person moves so that they don’t irritate the damaged tissue or structures.

Mechanical pain that is inconsistent raises the prospect that biochemical irritation and perceptual issues may be playing a role. And whilst this type of mechanical pain is harder and often takes longer to alleviate, it is still possible to achieve a substantial reduction in pain by reducing inflammation and tenderness with cold therapy, using “hands on” techniques to reduce soft tissue and joint tension and then unloading the irritated tissue / structure so that it can heal.

As long as the lesion is then protected from re-injury, there is no mechanical reason why it can’t repair. There are however nutritional and psycho-social reasons why a person may not get better which brings us to….


Biochemical / Nutritional Pain
It stands to reason, that if your body is to heal and be healthy, it needs the building blocks to make the necessary tissue for healing and repair. Without the essential nutritional elements, no repair is possible. What is shocking in this day and age, is that not only are many people not getting adequate nutrients for repair, but that their diet is actually sabotaging their health and healing response.

Let me explain.

What you eat can cause inflammation and lead to inflammatory diseases that include everything from pre-mature ageing, allergies, chronic pain, osteoarthritis, diabetes, fibromyalgia to Alzheimer’s disease, cancer, osteoporosis, depression, heart disease and more2. A diet of highly processed and refined carbohydrates, that is too low in omega 3 fatty acids (optimal ratio of omega 6 to omega 3 fatty acids is 2:1 to 4:1) and anti-oxidants and contains allergens and reactive foods or toxins will lead to inflammation and eventually pain. And a diet that is deficient in nutrients can cause specific health problems such as vitamin B12 deficiency which can lead to burning neuropathic pain.

So how do you know if you have a food allergy, reactive food or poor diet that may be causing inflammation? By listening to your body and taking note of any clues that it might be giving you. How do you feel after a meal and is your body displaying any signs of nutritional deficiencies? For example, do you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails have white markings (possible zinc or B6 deficiency), horizontal ridges and grooves (possible vitamin B or protein deficiency) or yellow vertical lines (possible deficiencies of keratin, calcium, magnesium, zinc, or sulphur). And what about your tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools? All these areas of your body can display specific, easily detectable signs that indicate your diet is lacking nutrients that may be leading to poor health, inflammation and pain.

The best place to start is with an assessment, especially if you are at all worried that your diet may have deficiencies that may be affecting your health adversely either now or in the future. Remember, many diseases show up only after years of neglect and could so easily have been prevented with strategies such as having more:

  1. High quality protein (at least 0.8gms for every kilogram of a person’s body weight);
  2. Oily fish (at least 3-4 meals per week);
  3. Complex carbohydrates by substituting wholemeal bread for bread for wholegrain sourdough or white rice for brown rice;
  4. Fruit and vegetables to supply antioxidants and alkalize your body;
  5. Filtered water (at least 2 litres daily, not with a meal if you are over 40) and less coffee, alcohol or soft drinks;
  6. Taking a probiotic daily as well as other supplements as indicated to correct any nutritional deficiencies and to enable your body to begin the journey back to full health.

These are just some of the many other quick and easy diet changes that can make a massive difference to your health. For more information or for an assessment, call us here at Bodywise Health on 1300 BODYWISE (263 994) and will be deighted to assist you and provide you with any additional informationthat you may want.


Emotional / Psychological Pain
Yes, how you think and what you feel can cause inflammation and pain. As Dr Craig Hassard says in the film The Connection, “If your brain is happy, then your body is happy”.3

Whilst the link between mind-body health has been recognised for more than 50 years, the past 10 years has seen an explosion in learning and evidence that indicates just how strong this link is.

What is fascinating is that it is NOT your reality, but how you perceive and interpret your reality that determines your health.

Research by Dr Lorimer Mosely at Oxford University using mirror therapy has shown that displaying a person’s healthy, normal hand has led to a reduction in inflammatory signs and symptoms of their affected hands by chronic regional pain syndrome. And projecting normal walking legs of amputees has eliminated their phantom pain.4,5

Emotions such as fear, anger, despair and sadness have so many far reaching consequences for your health. In life, they are absolutely appropriate when matched to the appropriate situation or circumstance. They can be absolutely critical for self-preservation in enabling you to adapt and survive when challenged by real threats to your safety and health. They often operate at an instinctual and reflex level as they are under the control of a more primitive area of our brains, the amygdala.

However, these emotions are meant to be turned on and then turned off. Problems arise when they become switched on so often by situations such those involving relationship difficulties, financial pressures and time constraints, that they become prolonged and "normal".  This then leads to a heightened state of tension, a hypersensitive nervous system, a less effective digestive system and a dysfunctional immune system and eventually to inflammation and pain. An example of this is depression which has a major inflammatory component.

The good news is that these emotions and thought processes can be overridden with hard work. Research has shown that the anteromedial portion of the prefrontal cortex (at the front part of the brain that deals with episodic memory, reasoning, attention, multitasking, task sets, decision making, cognition and processing of self-referenced information) can override the more reflexive, innate thought and behavioural processes.

There are many specific psychological therapies that can help people overcome inappropriate, instinctual mental and physical responses to everyday situations. A common denominator of successful approaches in achieving long term, sustained, independent improvement, is the active involvement of a person in their treatment along with the support and empowerment of an appropriately qualified health professional (psychologist etc. registered with The Australian Association for Cognitive Behaviour Therapy), with additional support as needed (e.g. family, friends etc.). Some of these approaches include:

1. Cognitive Behavioural Therapy;
2. Stress inoculation;
3. Stress desensitisation;
4. Meditation (Mindfulness, Emptying, Transcendental);
5. Relaxation training;
6. Biofeedback;
7. Neuro-Linguistic Programming (NLP).

It is beyond the scope of this blog to go into detail with each of these therapies. Suffice to say that if you are feeling stressed, out of control, not coping and or things are affecting adversely your everyday life then seek help from your GP or a qualified psychotherapist.

Whilst these different therapies, may use different techniques, their common purpose is to:

1. Empower you to reinterpret previously perceived stressful events in a more appropriate way and;
2. Impart knowledge and skills so that you can more effectively deal with and respond to these “stressful” situations in a healthier way.

These approaches also have in common the practice of techniques that interrupt your everyday thoughts followed by the active repetition (and learning) of better and more beneficial responses. Research has indicated that it takes about 300 to 500 repetitions to learn a new habit.6 However, to unlearn, correct and then re-learn a habit has been estimated to take about 3,000 to 5,000 repetitions.7 However long it may take you to learn how to initiate your own relaxation or healing response, it has been found that the more involved, engaged and emotionally connected you are with your responses, the faster and more complete your recovery.

Please understand that everything that you think, say and do, is a habit and a result of neural and immunological programming that has occurred both innately and via experience. Recovery lies with the fact that you can learn, grow, adapt and change in response to your changing world and circumstances.

Yes, it will take hard active work to change your “unhealthy” physical, nutritional and psychological habits and replace them with healthier ones, because in effect in so doing you are changing the neural programming that goes with each habit. To change a habit takes at least a month of reinforcing a new habit to such a degree, that it becomes the default, instinctive, reflex neural pathway and habit. It requires active involvement and commitment of a person as well as outside support, education, instruction, coaching, home-work and accountability. You are much more than just the product of your genes, your parent’s history or even your perceived “story” about yourself. Each and every day is your opportunity to forge a new path for your health and your life. Good luck in your journey.

If you are concerned about your physical and nutritional health, and would like to know if you have any deficiencies which may need correction, please call Bodywise Health on 1 300 263 994 (BODYWISE) to book your FREE physical health check or nutritional assessment.

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).

Additional References:

1. Australian Health Survey, First Results, Australia, 2011-12
2. Chadwick V. Mcphee R. Ford A. a Practical Guide to Clinical Nutrition for Allied Health Professionals. May 2014
3. Harvey S. The Connection Mind Your Body 2014
4. Moseley G. Distorted body image in complex regional pain syndrome. Neurology 65 September 2005
5. Moseley G. Effect of sensor discrimination training on cortical reorganisation and phantom limb pain. The Lancet Vol 357 June 2001
6. Schmidt, R. Motor Learning and Performance 2nd edition. Champaign, IL:Human Kinetics, 2000.
7. Chek, P. Primal Pattern Movements. A Neurodevelopmental Approach to Conditioning, 2003

 

 

 

 

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Sports Injury Clinic Melbourne

sports physiotherapy
By Michael Hall

Australia is a country of sports lovers and Melbourne is often called the sports capital of the world. In Melbourne, sport has a special place in our culture and lifestyle. Whether it be aerobics, swimming, cycling, jogging, golf, tennis, soccer, netball or Australian Rules Football, Australians love to be involved in either watching or playing sports. An unfortunate consequence of this however, is a sports injury. Simply stated, a sports injury is an injury that is sustained while playing sport. A sports injury may involve muscles strains, joint sprains, stress fractures, knocks, bumps, dislocations, tendinopathies and overuse injuries. While there are some similarities between sports injuries and those sustained while doing other life pursuits, sports injuries do have some unique characteristics that make it a specialized field of medicine.

What are the similarities?

The location of injuries

For example, an ankle sprain sustained playing tennis is basically the same as one sustained falling downstairs.

The severity of injuries

No matter where or how an injury has occurred, there are three grades of strain (muscle) or sprain (joint). These are:

• Grade I – involves 50% or less of muscle or ligament fibers torn

• Grade II – 99% to 50% of muscle or ligament fibers torn

• Grade III – is a complete rupture of the muscle or ligaments

The healing pathway

No matter where or how an injury has occurred, the body will attempt to heal it by going down the same healing pathway. There are four stages:

1. Bleeding Phase: relatively short time immediately following injury;

2. Inflammatory Phase: where the immune system is activated to protect the body against infection and clear the area in preparation for the laying down of new tissue;

3. Proliferation Phase: which involves the laying down of the repair tissue;

4. Remodeling Phase: where the repair tissue is organized and normalized.

How sports injuries are different

However, sports injuries are also different in a number of ways.

1. The location of injuries with some being related to particular sports (e.g. tennis leg = calf strains; jumpers knee = patella tendinopathy; swimmer shoulder; tennis elbow; golfer’s elbow etc.)

2. The start and end point of the injury. In other words, the people sustaining sports injuries are likely to be “fitter” and they will likely need to be in better physical shape and need a higher level of rehabilitation to return to their sport than those people who do not play sport.

What to do immediately after a sports injury

You can save yourself weeks and perhaps even months of treatment if you correctly use the RICE principles immediately after sustaining an injury. Here’s what to do:

Rest - From aggravating movements

Ice - Apply ice or a frozen gel pack wrapped in a damp towel for 15 minutes every one to two hours to reduce bleeding, swelling and further tissue damage

Compression - Firmly bandage the area to control swelling

Elevation - Elevate your injury higher than your heart to reduce swelling

At the same time, you must avoid HARMing your injury, especially within the first 72 hours. That is, you need to avoid:

Heat

Alcohol

Running

Massage

Sports injury treatment – taking the next step

Sports injury treatment must vary from other injury treatment programs in that the starting and end points require a much higher level of conditioning. What sets sports apart from other life pursuits is that the forces involved can be both extreme and varied.

Successful sports injury treatment must therefore take into account your physical characteristics and condition. In addition, successful sports injury treatment must also take into account the physical demands of your sport as these will often determine the type and severity of injuries that are sustained.

Your treatment, rehabilitation and training must then be geared to address and exceed the specific demands of your sport so that you have a reserve capacity which protects you when you are fatigued or your game goes to the next level.

The Bodywise Health Advantage

If you want the fastest healing, the best repair and the most complete recovery, Bodywise Health is uniquely positioned to assist you best. Bodywise Health is set apart from other sports injury clinics such as Sports Injury Melbourne, the Sports Injury Clinic Melbourne and Melbourne Sports Injury Clinic by better understanding you, your wants needs and goals.

Like Sports Injury Melbourne, the Sports Injury Clinic Melbourne and Melbourne Sports Injury Clinic, we use cutting edge technology and the latest evidenced based, proven treatment techniques to get you the best possible results in the fastest possible time.

For than 20 years, Bodywise Health has been delivering exceptional sports injury results to thousands of elite and recreational sports people in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Elsternwick, Elwood, Black Rock, Beaumaris and more generally Melbourne. With such a track record of achievement, you can have confidence that you will also experience exceptional results at Bodywise Health.

The contact details for Bodywise Health may be found by googling sports injury Melbourne, sports injury clinic Melbourne, Melbourne sports injury clinic, sports injury Bayside, Sports injury Brighton, Sports injury Hampton and sports injury clinic Cheltenham.

Let’s get started...

Whether you are a weekend warrior or an elite athlete competing at the highest level, the therapists here at Bodywise Health can design the perfect treatment and rehabilitation program to get you back to your sport fast.

Your recovery begins with the formulation of your optimal Recovery Action Plan. This includes a:

1. A comprehensive assessment to identify the sources, causes and healing stage of your problem as well as determine your physical strengths and weaknesses and the demands of your sport;

2. Clarification of your goals, concerns and aspirations;

3. The formulation of a treatment plan with an agreed timeline;

4. The implementation of the treatment program, with frequent re-evaluations to ensure

Your Recovery Action Plan is invaluable as it gives you peace of mind and a sense of certainty knowing that you are on track and to meet and exceed your goals.

If you want the best, fastest results; if you want the most optimal recovery possible; if you want to take your performance to the next level, call us here at Bodywise Health on 1 300 BODYWISE (263 994). We look forward to working with you so that you achieve everything that you want and more.

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 doctor. For more information, please call Bodywise Health on 1 300 263 994.

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Workplace Injury Treatment Melbourne

work injury treatment,  the injury clinic
By Michael Hall

Workplace injury has its own unique stresses, demands and requirements. This is why work injury treatment is governed by the Work Injury Management Act. The Work Injury Management Act details the steps as to how work injury treatment is to be administered for a workplace injury. It is a recognition that business pressures, time deadlines, physical, psychological and chemical stresses, productivity concerns and relationship tensions make treating work injuries challenging and complex.

Let’s start at the very beginning...

The best place to start is how to prevent a workplace injury. Doing a work place audit to analyze a work place environment as well as the physical, psychological and chemical stresses, can be invaluable in identifying potential work place hazards, long before they turn into injuries and preventing the need for work injury treatment in the first place.

Coupling this knowledge with the knowledge of the physical (and psychological) capacity of workers, will highlight whether particular people might be at risk. This will enable changes to be made proactively, perhaps through the retraining of staff, ergonomic alterations or adjustments made to systems.

Ok, a workplace injury has occurred, what do I do next?

First aid! This means ensuring the area is safe, before assisting the injured worker. Checking for vital signs (Airway, Breathing and Circulation) is of paramount importance as is calling for assistance.

If the injury is one that is musculo-skeletal in nature, weeks and perhaps even months of treatment may be saved if the RICE principles are correctly applied immediately after sustaining an injury. Here’s what to do:

Rest - from any aggravating movement

Ice - Apply ice or a frozen gel pack wrapped in a damp towel for 15 minutes every one to two hours to reduce bleeding, swelling and further tissue damage

Compression - Firmly bandage the area to control swelling

Elevation - Elevate your injury higher than your heart to reduce swelling

At the same time, you must avoid HARMing your injury, especially within the first 72 hours. That is, you need to avoid:

Heat

Alcohol

Running

Mssage

Even if the injury is not life threatening, it is still imperative that supervisor(s) are notified and that a written report is made. Following this, it is advisable for the injured worker to have a medical examination. This enables the doctor to then direct treatment, and to ascertain whether the worker might require further medical investigation or perhaps be referred directly for rehabilitation.

The Bodywise Health advantage

By listening to your concerns, understanding your fears, determining the diagnoses, identifying your needs, analyzing the demands and clarifying your goals, enables us to personalize treatments and implement targeted rehabilitation plans that deliver real results, both for you and your organization.

The systems that we have developed working with some of Australia’s biggest companies including Myer, Australia Post and Coles in the InjuryNet program over the past six years, has enabled us to assist people to stay at work whilst enabling them to get better, often within four treatments, saving thousands of dollars and much stress and anxiety in the process.

Getting better quickly is the only choice. It saves time, money, stress and prevents worry and misunderstanding and provides the best possible outcome for all parties.

Work injury treatment – taking the next step towards recovery

What sets work injury treatment apart from the treatment of injuries sustained in other walks of life is the fact that they occur as part of person’s work. Successful work injury treatment not only requires an intimate understanding of the injury, it also requires an understanding of the work environment, the physical demands and biomechanical considerations of the work itself as well as other physical, psychological, chemical and social factors. For example, a gardener with a back problem will need a different conditioning program to a fireman. Consequently, each rehabilitation and conditioning program must be tailored not only to each person’s needs, but also to the demands of the work that they do.

The Bodywise Health Advantage

If you want the fastest healing, the best repair and the most complete recovery, Bodywise Health is uniquely positioned to assist you best. From assessing your injury, to determining the diagnosis, to providing fast relief, optimal healing, targeted rehabilitation, work ergonomic assessment and work specific conditioning, our therapists have the knowledge, skills, equipment and passion to help you achieve the best results at the fastest possible rate.

Let’s get started...

Whether you are a builder, baker or a banker, the therapists here at Bodywise Health can design the perfect treatment and rehabilitation program to get you back to your work fast.

Your recovery begins with:

1. A comprehensive assessment to identify the sources, causes and healing stage of your problem as well as determine your physical strengths and weaknesses and the demands of your sport;

2. Clarification of your goals, concerns and aspirations;

3. The formulation of a treatment plan with an agreed timeline;

4. The implementation of the treatment program, with frequent re-evaluations to ensure

Not only does this set clear expectations, it gives you a sense of control and certainty knowing that you are on track and it gives us a target to meet and exceed.

But it all begins with you. You must take the first step. Once on board, we will be there to help you every step of the way. The sooner we begin, the sooner you get back to doing what you want to do. Let’s get started...

For more information or for an appointment, please call Bodywise Health on 1 300 263 994.

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 1 300 263 994.

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How to choose the correct running shoe

core
By Michael Hall,

Looking to buy your next pair of walking or running shoes? Where do you start? The plethora of shoes available can only compare to the number of mobile phone plans that are on the market. It is a confusing array of shapes, colours, materials and densities, all designed to address a particular want, need and function. But how do you decide which shoe is going to work best for you, giving you the style, performance and protection that you desire? This article goes in search of those answers, so that you can make better informed choices as to what footwear is appropriate for you, rather than having to rely on some marketing gimmick or the advice of a fresh faced just out of school sales assistant.

The barefoot running phenomenon

What is not often appreciated is that walking and running are whole body activities, involving a complex symphony of muscles, joints and body parts all working in synergy to propel you forward in the most efficient, effective manner possible. If you walk or run too bent forward or too far back or have poor muscle strength and control (especially your glutes, quadriceps, calf and or foot muscles) or have inadequate joint mobility (especially backwards bending of the hips and ankles), you will be predisposed to injury no matter what shoe, orthotic or even surgery you have.

Even reducing your arm swing will change the efficiency and effectiveness of your motion and have biomechanical implications throughout the rest of your body. Any deficiency or motion lost in one direction will be regained as excessive motion in the least desirable direction, in the least desirable body part. And because walking and running are repetitive, cyclical activities, any problem not addressed will only get worse.

Structural interventions such as shoes, orthotics and surgery may be part of your solution, but to completely resolve associated back, hip, knee, ankle and foot injuries, you must have an assessment and get your faulty movement pattern corrected, otherwise your injuries will just return.

For a foot assessment and a walking evaluation, please call Bodywise Health on 1 300 263 994 (BODYWISE).

Back to basics

Walking and running both involve an incredibly complex interaction of muscles, joints, limbs and motions, all performed under the subconscious control of the brain. To coin a phrase, “You just do it”, but that doesn’t mean that you “do it” correctly!

Pronation is not a dirty word

Walking and most often running, involves a heel – toe pattern. Generally, the outside of the heel should hit the ground first (50’s supination).3 The centre of gravity of your body (gaitline) should move from the outside to the inside of the heel and then curving forward starting towards the 4th toe, to the 3rd toe before trailing off between the 1st and 2nd toe as you push off. The slight inward flattening the inside of the foot (pronation) is important, because as the inside of the foot flattens (pronates), the forefoot is unlocked so that it can accommodate to the ground, thereby improving your foot’s surface contact and giving you better grip, balance and agility. It also enables the impact shock to be better absorbed and dissipated throughout the joints and muscles of your foot, ankle, knee, hip and pelvis thereby helping to prevent stress fractures (e.g. March fractures), jarring injuries (e.g. fat pad inflammation) and ankle sprains. The downside of excessive pronation is not only an increased risk of injury, but that it is less energy efficient (i.e. more tiring), as the elastic recoil of the foot joints and muscles are reduced.

fig1

Figure 1.  Left image Normal-Note gaitline moves towards the 3rd toe before trailing off between the 1st and 2nd toes. Middle Image - Pronated (flat) foot. Right Image - Supinated (high arched foot)

For a foot assessment and a walking evaluation, please call Bodywise Health on 1 300 263 994 (BODYWISE).

What type of feet do you have?

There are five main foot types: Which one do you have?

fig2

Is GaitScan the best assessment tool for feet during walking / running?

Here at Bodywise Health, along with other tests, we use GaitScan to evaluate the functioning of feet during the walking / running cycle. GaitScan is a computerised assessment tool that not only illustrates the GaitLine but also indicates the specific amount of pressure and the timing of pressure of each part of your foot at 300 times per second as your body passes over your foot during walking.

The beauty of GaitScan is that it gives objective data of your foot mechanics as you walk. This data is then directly able to determine what foot type you have. To identify which shoe will best suit you is then a simple task of matching your data with the corresponding shoe.

For a foot assessment and a walking evaluation, please call Bodywise Health on 1 300 263 994 (BODYWISE).

fig3 fig4 fig5

Which shoes for which feet?Runners who have pronated feet need a dual density midsole that is harder on the inside than the outside to prevent excessive flattening motion (pronation).If you are a wholefoot pronator, the increased density midsole should extend from the inside back of the sole of the shoe to just before the ball of the foot.
If you are a forefoot pronator, the increased density midsole should be slightly further forward extending from the inside of the front of the heel to just before the ball of the foot.If you have a supinated foot, you need extra shock absorption with a shoe with a soft midsole that still provides outer stability.
The table below summarises the recommended running shoe features for each foot type.

fig7

Fig 3.  Heel counter, the back of the shoe above the sole

fig9

Figure 5. Note Shoe on the left has a straight Last whereas as the shoe on the right is curved.

  

Running Shoes

The best running shoe for you should match your foot type, as well as your individual wants and needs.  Running shoes should not attempt to change your foot shape, but rather work with your foot, running style and purpose to prevent injury and give you the best possible performance. There are several features of shoes which are important for correct foot function.   These include:

1.The front of the shoe should be flexible and bend easily along the curve of where your toes meet your foot (metatarsal phalangeal joints).

2. The heel counter, the upper rear part of the shoe should be made of rigid, firm plastic to assist in rear foot stability.

3. The midsole is probably the most important feature of a running shoe as it attempts to balance the competing demands of shock absorption with motion control. If the midsole is too soft, it may be great for absorbing shock but lack the stability to prevent overstretching of the foot and ankle structures. If the midsole is too hard, it may provide good motion control but provide insufficient shock absorption to prevent stress fractures and jarring injuries. Some shoes have a flared midsole in an attempt to reduce impact forces. However, these shoes also promote rapid and excessive foot pronation and should be avoided.

4. The last or mould construction of the shoe may be straight, semi-curved or curved and should be matched to the individual shape of your foot. 2 There is no evidence however, to support the commonly held view that the shape of the shoe influences foot function.

  

fig6Figure 2 Figure 2 A. Incorrect. The outside of the shoe where the toes bend is more distal than the inside; B Correct. Where the shoe bends matches where the toes bend.

fig8

Figure 4 Note the heel is higher than the forefoot to compensate for limited ankle backwards movement.

   

The 3 Point Testing System


The American Academy of Podiatric Sports Medicine uses a basic 3 - point testing methodology developed by Mark Reeves, DPM, of Seattle for evaluating athletic shoes.
The focus of the testing is primarily on whether the shoe has a firm heel counter, whether the shoe has a firm resistance to torque when the heel and toe are twisted in opposite directions, and whether the most distal third of the shoe flexes easily while the middle third resists flexion. These techniques are all performed manually and can be done easily in shoe stores or in the office. The three-part test is quick and easy and provides objective metrics because it is repeatable and results can be compared from shoe to shoe.

 

Forefoot Shoe Break “Flexion” Test



The most important factor in evaluating any type of athletic shoe is the ease of bending of the most distal third of the shoe and the stiffness of the middle third of the shoe. 6

The optimal amount of bending, compression and stiffness depends on your foot type. Shoes with a rigid sole, may cause excessive stress to the calf muscles as well as lead to early heel lift and knee bending at push off.5 On the other hand, very compliant or cushioned shoes may possibly increase the risk of injury by allowing excessive sub-talar joint mobility (i.e. in and outward movement of the ankle joint).7,8 However, for people who have high arches (i.e. supinated feet), the increased shock absorption offered by highly cushioned shoes may help to protect from bone injuries often suffered by this patient population.9

Heel Counter – The Thumb Test

fig11

Figure 7.  Running show should have a firm heel counter.

The Thumb Test is used to ensure that the heel counter is rigid enough to control the rear foot.  It involves squeezing the heel counter with your thumb and index finger.  If the heel counter compresses, it is too soft and floppy.

 

Torsional Stability Test

fig12

 

Figure 8  The shoe should control the twisting of the foot in response to the environment and performance requirements.

 

 fig10

Figure 6 The most distal third of the shoe should flex easily while the middle third resists flexion.

Torsion (twisting) control in a shoe may play a more important role in sports in which sideways movement is of primary importance. In court shoes and trail running shoes, for example, the foot is placed in very different positions due to varying terrain or sideways movements while running, jumping, and landing. The shoe should be able to allow the foot to twist inward and outward as needed in response to these positioning stresses. In running shoes, an increase in motion-controlling properties built into a shoe often leads to a shoe that will be more resistant to twisting torque forces. This may be acceptable for most road-running on flat surfaces, but it won’t work in general for off-road running or other lateral cutting sports.

   

Which shoes for which feet?

Runners who have pronated feet need a dual density midsole that is harder on the inside than the outside to prevent excessive flattening motion (pronation).

If you are a wholefoot pronator, the increased density midsole should extend from the inside back of the sole of the shoe to just before the ball of the foot.


If you are a forefoot pronator, the increased density midsole should be slightly further forward extending from the inside of the front of the heel to just before the ball of the foot.

If you have a supinated foot, you need extra shock absorption with a shoe with a soft midsole that still provides outer stability.


The table below summarises the recommended running shoe features for each foot type.

 

 

 

 fig13

Figure 9. Note the firm material on the inside of the heel extends to the back of the shoe.

fig14

Figure 10.  Note the firm material on the inside of the shoe stops short of the back of the shoe.

fig15

Figure 11.  This shoe has extra cushioning and gel to absorb shock.

 fig16

Although the number and types of running shoes on the market are many and varied, there are just a couple of things that you need to keep in mind to determine what is going to work best for you. These include your individual physical characteristics, your running style and the intended purpose of the shoe.

You first need to understand that no shoe is going to compensate completely for faulty walking/running patterns or incorrect biomechanics. And yet, in light of this, it is difficult to quantify objectively your movement patterns and biomechanics.

Plaster casting of your feet in sitting or standing is not accurate because it does not directly relate to walking / running. To get an accurate indication of foot and overall body function for walking / running, you feet must be tested in the walking and running motion.

Videotaping also is not accurate as it involves the eye balling and then guesstimating the joint angles and muscle activations at particular points of the walking / running cycle.

If you are looking for exact measures of your walking and running mechanics, then perhaps the best test is the GaitScan assessment as it gives you the exact pressures and the timing of these pressures of each part of your foot during walking / running cycle.

For a foot assessment and a walking evaluation, please call Bodywise Health on 1 300 263 994 (BODYWISE).

Once you know how your foot functions during walking or running, it then becomes a matter of matching it to the correct shoe based upon objective validated tests rather than the shoe tests touted by many running magazines which are not backed up by the research.

The American Academy of Podiatric Medicine recommends using an evidenced based 3 point assessment protocol to evaluate shoes. Of paramount importance for pronated (flat) feet is the shoe’s distal flexibility as well as the mid-foot twisting control and heel counter rigidity. For high arched feet, cushioning and shock absorption are especially significant. Shoes that generally meet these criteria will, in general, provide you with better protection against injury as well as superior performance.

If you would like to know your foot type and what shoe will work best for you, we invite you to call us here at Bodywise Health for a foot and walking / running evaluation. This evaluation will include a report that you can give to a shoe retailing indicating what foot type you have so that they can better match the correct shoe for you.

For a foot assessment and a walking evaluation, please call Bodywise Health on 1 300 263 994 (BODYWISE).

For more information on how Bodywise Health can help you to recover from or prevent running injuries, 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 1 300 263 994.

References

1. Gallant JL & Pierrynowski MR. A theoretcical Perspective on Running. Journal of the American Podiatric Medical Association 2014; 104(2): 211-220.

2. Sahrmann SA and Associates. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. Elsevier Mosby 2011.

3. Norkin C and Levangie P. Joint Structure and Function. A Comprehensive Analysis. 3rd Edition. 2001.

4. Australian Orthotic Group. 2011 Australian Orthotic Group Seminar. Gait Analysis & Custom Orthotic Therapy.

5. Brukner P, Khan K and Collegues. Clinical Sports Medicine. McCraw Medical. 4th Edition, 2012.

6. Williams B. A three point approach to testing running shoes. Journal of Foot and Ankle Research. 2010.

7. Shorten MR. The myth of running shoe cushioning. Presented at IV International Conferenceon the Engineering of Sport, Kyoto, Japan, Sept. 2002.

8. Heidenfelder J, Sterzing T, Milani TL. Biomechanical wear testing of running shoes. Footwear Science 2009; 1 (S1): 16-17.

9. Butler RJ, Hamill J, Davids I. Effect of footwear on high and low arched runners’ mechanics during a plolonged run. Gait & Posture 2007;26:219-225

10. Stacoff A, Steger J, Stüssi E, Reinschmidt C. Lateral stability in sideward cutting movements. Med Sci Sports Exerc 1996;28(3):350-358./p>

11. Stacoff A, Kalin X, Stüssi E. The effects of shoes on the torsion and rearfoot motion in running. Med Sci Sports Exerc 1991;23(4):482-490.

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Bodywise Health Headache Treatment

acupuncture melbourne
By Michael Hall

Of all treatments, headache treatment probably ranks as probably the most misunderstood and confusing. Few complaints are more common than headaches or head pain. Yet, despite their frequency, much confusion and ignorance still surrounds the source and cause of headaches as well as to what constitutes the most effective headache treatment in Melbourne.

In fact for many years, the neck was completely ignored as a possible source of headaches by all the medical literature despite a considerable amount of evidence to the contrary. And indeed when headache was described it was given an incomplete, vague description, often only being referred to as tension headaches. Yet, this is despite the fact that muscle tension is not painful, but may lead to other structures such as joints and nerves to becoming painful.

Classification of Headaches

Many headache specialists in Melbourne classify headaches according to their presentation. This is important as it directs the most effective treatment for each condition. This classification includes:

1. Non-recurring headaches

2. Recurring headaches

(i) Migraine (vascular) headaches type

(ii) Headaches originating from cervical spine (neck) dysfunction

(iii) Combined migraine and cervical spine headaches

The Difference between migraine and cervical spine headaches

As physiotherapy treatment or physical therapy for headaches is most effective with neck related headaches, they must be differentiated from migraines which respond best to migraine headache treatments. These differentiating features include:

Periodicity: Neck headaches display a history of increasing periodicity and do not abate with age. In contrast, migraine headache periodicity hardly changes until they abate later in life. Headaches due to the jaw joint (TMJ) have an irregular periodicity. This factor differentiates cervical headaches from migraine headaches more reliably than any other factor.

Intensity of Pain: Neck headaches may be as painful as migraine headaches, though their intensity is more variable. The intensity of migraines is always severe.

Response to Painkillers (analgesia medication): A decreasing response to analgesics suggests a cervical origin. Migraine headaches in contrast respond minimally to compound analgesics (e.g. Panadeine Forte) and not at all to simple analgesics.

Onset: The onset of migraine headache is usually related to puberty whereas neck headaches may occur at any time in life.

Non-Diagnostic Features

Location of Pain: Both types of headache may refer pain to any part of the head. If pain encroaches on to the face it may also be referred from the TMJ.

Nature of Pain: Both headaches may present with the same pain characteristics including throbbing, pressure, pounding, gnawing and sickening sensations.

Triggers: Neck headaches can be triggered by all the migraine trigger factors.

Accompanying Symptoms: Neck headaches and migraine headaches commonly display the same symptoms such as visual disturbances, tinnitis, vomiting and dizziness.

The Sources of Headache

Migraine Headache

Pain arises from the dilation (that follows initial constriction) of pain sensitive arteries in the head. The cause of this vasoconstriction is not yet known. Headache is never the only symptom and may not even be a feature of the attacks. Migraine headache treatment is therefore directed to avoiding the triggers of migraine headache and preventing the migraine causing vasodilation of blood vessels.

Neck Headaches

Degenerative changes in the joints of the upper cervical spine (i.e. the 1st 3 cervical spine joints) are the primary source of neck headaches. The reason for this is that at these levels there is the greatest overlap of the nerves which supply sensation to the face and head (i.e. the cervical and Trigeminal nerves). Consequently, any irritation of structures close to these nerves may cause these nerves to transmit pain and lead to headaches. This irritation may occur in a single injuring event (e.g. whiplash) or over many years of poor posture and repetitive movement patterns. Through this, the lower cervical and thoracic spines may be a secondary source of headaches as if they become stiff (through poor posture), the upper cervical spine has to compensate by moving more, and it is this compensation which leads to degeneration and pain.

The Best Headaches Treatment

Bodywise Health headache physiotherapists have been delivering effective relief from headaches to people in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Elsternwick, Elwood, Black Rock and Beaumaris for more than 20 years.

The contact details for Bodywise Health may be found by googling migraine headache treatment, headache treatment Bayside, headache treatment Bayside, headache treatment Brighton, headache treatment Hampton and headache treatment Cheltenham.

Headache treatment gives the best results when it is guided by your presentation, a comprehensive, professional assessment and the clinical findings, your goals as well as your ongoing response to treatment.

The most effective physical therapy for headaches involve a combination of “hands on” therapy, electrotherapy, as well as physical conditioning and movement/relaxation retraining. This last point is extremely important because often it is poor posture/movement patterns which either perpetuate pain and dysfunction or cause it in the first place. It follows therefore that if the causes of headaches are not corrected, then only short term relief will be experienced.

If you live in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Elsternwick, Elwood, Black Rock and Beaumaris or more generally Melbourne and you want to achieve sustained relief from your headaches; if you want to be shown the physical, nutritional and psychological keys which will help to free you from headaches forever; if you want to take back control and reclaim your health and your life, then call us here at Bodywise Health on 1 300 BODYWISE (263 994) and begin your journey back to living your life without headaches.

For more information or for an appointment, please call 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 1 300 263 994.

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Foot Pain Treatment in Melbourne

Pain Treatment in Melbourne
By Michael Hall

Walking, running and in fact every time you put your feet on the ground, involves a complex interaction of the joints, muscles and nervous system control of your whole body. It stands to reason therefore, that all injuries which involve having your feet on the ground especially foot pain problems and foot pain from walking, must involve an assessment of the activity as a whole as well as an examination of each muscle and joint involved in the process.

This is the physiotherapist advantage.

Physiotherapists can analyze your standing, walking and running as a whole as well as break each movement down to its component parts. Physiotherapists can assess the mobility of your joints, the strength of your muscles and the control of your movements enabling them to determine deficits and analyze causes.

Physiotherapists can then use “hands on” techniques to free up specific joints, loosen specific muscles and mobilize your nervous system, techniques all designed to create the optimal environment for healing. These techniques also make rehabilitative exercise more effective, which makes postural and movement correction more effective. Consequently, all the treatment that we perform at Bodywise Health is not just directed at getting your back, hip or knee better, but importantly directed at getting you back doing the things you love to do whether be hiking in the country, walking in the park or going for a run.

The problem

Up until this stage there have been two problems.

The first problem was that assessments of foot pain problems and foot pain when walking often weren’t optimally objective, often involving observation or even video-taping a person as they walked or ran on a treadmill. These assessments still involved estimates of the biomechanics of the body.

The second was that assessments simply weren’t relevant. A plaster cast was made of the feet in sitting or standing, which had absolutely no relevance to walking or running. Therefore this type of assessment couldn’t adequately provide a solution for leg and body problems associated with these activities.

The solution

Gait scan has now changed all of this. Now assessments of foot pain when walking are both relevant and objective. Gait scan scans each foot, measuring the amount and timing of pressure from each part of the foot at 300 times per second as you stand, squat or walk. This objective data has been validated and verified and an enormous data bank of information has been gathered in the 25 years it has been used in Canada. By comparing your gait scan data with the existing data and combining this with information gained through a clinical examination, accurate, objective clinical findings can be made not just for your foot, but for your knee, hip and even your back.

Gait scan is a fantastic tool for foot pain walking problems as it provides the objective clinical details needed to provide long term orthotic solutions for foot pain problems. These include problems such as plantar fasciitis, heel spurs (pain on the under surface of the foot), hallux valgus (big toe pain), meta-tarsalgia (toe pain), mid-tarsal joint arthritis, chondromalacia patellae (knee cap pain), iliotibial band fasciitis (pain on the outside of the knee) and many others.

Gait scan orthotics permanently change the physical stresses on your body every time you stand. By doing this, they can permanently unload or eliminate the stresses on your painful body part, thereby providing permanent relief. Combined with “hands on” soft tissue and joint techniques as well as precise corrective muscle activation training, balance, walking/running and functional retraining, gait scan orthotics provide the ultimate in long term relief and improved physical performance of many activities.

Experience permanent relief, not just a quick fix

Gait scan orthotics permanently remove the physical stresses on your foot pain problems every time you stand, walk, squat, lunge and run, thereby providing you with permanent relief. Combined with “hands on” soft tissue and joint techniques as well as precise corrective muscle activation training, balance, walking and running retraining, gait scan orthotics provide the ultimate in long term relief from foot pain from walking as well as improved physical performance of many activities.

So if you experience foot pain problems, especially foot pain from walking or have long term foot, ankle, knee, hip or even back problems, gait scan orthotics may be the answer that you are looking for. They may save you months of therapy and years of pain.

For more information or an appointment, 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 1 300 263 994.

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Chronic Pain Treatment Melbourne

east brighton physiotherapy
By Michael Hall

Chronic pain is pain that is constant, relentless, draining pain for longer than 12 weeks. Unless you have had it, you can’t imagine it. It may involve back pain, neck pain (whiplash), migraine / headaches, tinnitus (ringing in the ears), phantom limb, fibromyalgia / fibrositis, chronic regional pain syndrome (CRPS) pain.

Chronic pain may affect every part of life, from sleeping, to morning to night. Every posture, movement, every activity, every word, every thought, every moment may be coloured by its presence until it becomes all consuming,

Chronic pain is serious

So pervasive, so invasive is chronic pain that it can wear you down, until it breaks you. Apkarian et al (2004) showed that people with chronic low back pain had lost 5-11% of neocortical brain matter, or 1.3cm3 of brain grey matter for every year of chronic pain. This is equivalent to 10-20 years of normal aging. The seriousness of dealing appropriately with chronic pain could not be more apparent.

Chronic pain is complex

One thing that is clear is that chronic pain is complex involving a complicated interplay of almost every bodily system. The sensations that we experience through our senses (sight, touch, hearing and smell), are transmitted to the spinal cord and then on to the brain. In the case of a severe pain, a response may be initiated from the spinal cord (reflex) directly as in the case of pulling our hand away from a fire. The brain also receives the information and on-sends it to all many different areas for processing, interpretation and the initiation of a response. These responses may affect all systems of the body from the activation of a movement, to changes in the immune system, to changes in the autonomic system. Essentially these responses have to do with either a protective response (fight or flight) or a nurturing growth and repair response.

Fight or Flight Vs Growth and Repair

The response that is activated depends upon how the stimulus is perceived. Our most primitive, automatic response is one of fight or flight. In the case of a perceived pain, threat, or fear, our body is readied to fight or take flight as our awareness is heightened, our heart pumps harder, breathing quickens, perspiration increases, muscles are tautened. At the same time, blood is diverted away from the digestive system and the nervous system is put on alert as the immune system is “deactivated”. In other words, our need to survive is prioritized ahead of every other need of the body, including growth and repair. This survival instinct, in the case of short term threats to our safety, is appropriate to help us stay alive. However, with repeated exposure to this pain, threat or fear, and repeated activation of the fight and flight pathway, our body’s ability to grow and repair may become impaired.

The brain is a computer with no delete button

The brain learns from every experience and may draw on the learning not just of this sensation, but of how the sensation is perceived you felt about this experience in the future. This means, just thinking about the experience is enough to trigger a response, irrespective of whether there is a problem with the body’s tissues or not. Moseley (2008) found that just imagining a body part worse than it is can increase the swelling and perceived pain, whilst imagining it better than it is can reduce the swelling and perceived pain. Maihofner et al (2006) also found that not only could the pain be magnified but that its location couldn’t be accurately identified. And further research has also shown that chronic back pain is experienced in a different location of the brain when compared with acute back pain (Moseley 2008).

Other studies have shown that using the reflection of an unaffected limb has reduced the pain experienced by individuals with their affected limb. Amputees have also been shown to have reduced phantom limb pain when their “legs” are projected walking underneath them on to a screen. What these studies show is that pain may not just be experienced at the local level but that chronic pain changes the brain biochemistry and actually rewires the brain’s neural pathways. This has major implications for the treatment of chronic pain and necessitates a holistic, multidisciplinary approach, if treatment is to be successful.

So where to begin

Given chronic pain’s complexity, chronic pain treatment or chronic pain management must tackle chronic pain on multiple levels, psychologically, physically and socially. Having said this, these levels may fall into two broad categories. The first is to discourage an environment of excessive or abnormal stress which may lead to a fight or flight response. The second is to encourage an environment of healing, repair, growth and building capacity.

Here are 7 guidelines of how chronic pain therapy and chronic pain clinics must deal with chronic pain

  1. The first rule of many chronic pain management clinics is to acknowledge that chronic pain is real. Sometimes not being believed is the most difficult thing to deal with especially as chronic pain can’t be seen, imagined or picked up on a scan.
  2. Have hope that chronic pain can be overcome. Gaining an understanding of the complex mechanisms behind chronic pain can help to give this sense of hope as well as a sense of control and empowerment.
  3. Change your attitude and change your behavior. Easier said than done, it is important to see yourself not as a victim of chronic pain, but as a person who has choices and things that they can control. If you can focus on those things that you have control over and your control them perfectly, many of the things you can’t control will go away.
  4. Create an environment which encourages nurturing, growth and repair. Being supported by and feeling connected with others is important as is sleeping well when most growth repair occurs. Food which reduces inflammation (fish/krill and flaxseed oil, turmeric and ginger) and which assists with growth and repair (vitamin C, Activated B and adequate amounts of protein) may also assist. Relaxation techniques, meditation, prayer or even warm baths can all be used as strategies to help to reduce tension and promote an optimal healing environment.
  5. Whilst there is no evidence that hands on techniques (such as remedial massage and mobilization) and modalities such as heat is of benefit, at Bodywise Health we have found that they may help exercise to be more beneficial by reducing sensitivity and increasing exercise tolerance.
  6. For maximal benefits, exercise should first be directed towards increasing joint mobility, improving muscle length and balance with the objective of correcting and optimizing posture and movement patterns. For these exercises to be effective, they may be performed under the pain cover of heat, cold or electrical stimulation and must start at an intensity which is below pain thresh-hold. Then using the overload principle, this postural exercise program should be increased first in volume and then in intensity, so that a training effect may be experienced which carries over to sustained physical improvement.
  7. Taping or bracing may be used to “unload” hypersensitive body tissues and enable assisted accommodation of correct posture, further reducing physical forces on the body’s structures.

Chronic pain management doctors and the chronic pain specialist in chronic pain management clinics across Melbourne may prescribe non-steroidal anti-inflammatories and opioids to manage chronic pain.

Chronic pain management Melbourne may abide by the evidence which suggests that non-steroidal anti-inflammatory (NSAIDS) medication should be considered as an appropriate treatment for chronic low back pain. However, whilst there are demonstrated benefits, there are also significant side effects that may have meaningful clinical consequences. NSAIDS are favoured over opioids both in terms of cost and safety. (Roelofs et al 2008)

Whilst dealing with chronic pain is extremely challenging, it is important to know that hope is at hand.

With Bodywise Health providing physical, nutritional and psychological services, we are well placed to assist chronic pain sufferers. Whilst medication may have its place, it doesn’t empower you as to how to avoid chronic pain stresses nor build your capacity to tolerate stress. Unless you are enrolled into an appropriate, graduated, progressive and empowering physical, psychological and nutritional training program, it is likely that your ability to cope with everyday life will decrease over time.

Unlike medication which can become a “crutch” upon which the body becomes dependent to cope, Bodywise Health’s philosophy is to empower you, your body and mind, by giving you the knowledge, training and resources that enables you to get stronger, physically, mentally and nutritionally.

Bodywise Health has been providing chronic pain management solutions to the people in the Bayside suburbs of Hampton, Brighton, Sandringham, Highett, Cheltenham, Black Rock, Beaumaris, Elwood Elsternwick and more generally across Melbourne.

Bodywise Health contact details can be found by googling chronic pain management Melbourne, chronic pain management Bayside, chronic pain management Brighton, chronic pain management Hampton or chronic pain management Cheltenham.

Bodywise Health will work with any chronic pain specialist or chronic pain management doctors in Melbourne to ensure that you experience the best results possible.

The Bodywise Health chronic pain management program has had great success in assisting hundreds if not thousands of people over the past 20 years. It can help you too.

For more information or an appointment, please call Bodywise Health on 1 300 BODYWISE (263 994).

You have nothing to lose except your pain.

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 1 300 263 994.

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Bodywise Health

364 Hampton St,

Hampton

Victoria. Australia 3188

03 9533 4257

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