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5 Secrets to Overcoming Your Injury

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

 

Read more...

Why You Need More than a Diagnosis To Get Better

Body wise 291011-17-Edit-Edit-Edit

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

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

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

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

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

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

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

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

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

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

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

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

Joints become red and swollen.

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

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

Nerves become hypersensitive and restricted.

Connective tissue (fascia) becomes taut and fibrotic.

Blood flow may be compromised.

The surrounding environment may become acidic.

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

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

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

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

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

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

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

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

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

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

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

Two weeks later Ann left for overseas with minimal pain.

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

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

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

You must correct the biomechanics, posture and movement patterns.

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

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

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

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

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

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

Wishing you the best of health and life.

Michael Hall
Physiotherapist
Director, Bodywise Health


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

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

References available on request

Read more...

Arthritis Latest Research Gives You New Hope

Interview 008
 
 
If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 
 
New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.
 
Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.
 
The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.
 
Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.
 
Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.
 
Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.
 
Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.
 
However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.
 
How do you do that? Here are some tips.
  1. If your pain is consistently from certain physical postures, positions, movements or activities you need to:
  2. Avoid or at least change the way that you perform these behaviours so that they become non painful.
  3. Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.
  4. Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.
  5. Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.
  6. Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.
 
Nutritionally you need to:          
  1. Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.
  2. Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1
  3. Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.
  4. Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).
  5. Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?
  6. Eat high quality protein (>0.8 gms/kg per day).
  7. To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.
  8. For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.
 
Psychologically you need to:
Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 
 
It is beyond the scope of this blog to go into detail with management strategies. 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 arthritis can be painful and debilitating, this new research offers you hope. 
 
In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.
 
If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.
 
If you would like any help with any aspect of Getting Better, Staying Better and Living Better, please don’t hesitate to call us here at Bodywise Health on 1 300 BODYWISE (263 994). 
 
We would love to help you get back to living freely and without pain.
 
Wishing you the best of health and life.
 
Michael Hall
Director, Physiotherapist
Bodywise Health
 
For more information on how Bodywise Health can help you to overcome your pain, please call Bodywise Health on 1 300 BODYWISE (263 994).
 
Please note:
  • Rebates are available through your private insurance extras cover;
  • For complex or chronic conditions, you may qualify for the EPC (Enhanced Primary Care Program) allowing you to receive 5 allied health services each calendar year with a referral from your GP. For more information, please call Bodywise Health now on 1 300 BODYWISE (263 994).
 
References available on request

 

 

Arthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

It is beyond the scope of this blog to go into detail with management strategies. 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 arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

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

 

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

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on requestArthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

It is beyond the scope of this blog to go into detail with management strategies. 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 arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

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

 

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

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on requestArthritis Latest Research Gives You New Hope

 

If you suffer from Osteoarthritis or Rheumatoid Arthritis, recent research offers you new hope. 

 

New research published in the Journal Pain Practice, August 2017 indicates that it is inflammation and especially neuro-inflammation (inflammation of the nerves) rather than degeneration that is the cause of arthritis, especially osteoarthritis.

 

Inflammation is an immune response critical for healing. During this process, white blood cells are activated to break down and ingest damaged cells, thereby clearing the area for the laying down of new tissue.

 

The problem is that constant, long term irritation (greater than 6 weeks) from external forces (e.g. excessive physical loading) and internal forces (e.g. chemical / nutritional and psychological / stress / depression) can cause over-stimulation of your immune system so that it begins to breakdown undamaged or healing tissue, thereby impeding healing.

 

Nerves are like the communication and power lines in our body. They serve to give feedback to the brain (and spinal cord) as to what is happening from both inside and outside the body and then they provide the conduit for impulses to the body’s tissues (e.g. muscles) so that the body can respond.

 

Like power lines, they need to be able to mobile and to move as your body moves so that they don’t get tugged, caught or pressed on. If they do, then the result will be adverse reactions such as pain, pins and needles, numbness and even loss of power.

 

Nerves in particular can have a magnifying effect on the pain experienced with inflammation. Not only do they become over-sensitive to stimuli, they also become restricted in their mobility. This leads to nerve tension, irritability, soft tissue tension (e.g. connective tissue, muscle), joint restriction and stiffness and faulty postures and movement patterns, further perpetuating the problem.

 

Not only that, but your brain which initially acts as a receiver of pain then after about six weeks can become a transmitter of pain beginning and perpetuating the cycle of chronic pain.

 

However, what this new research means for you is that if you can reduce the inflammatory process, you may be able to limit and perhaps even turn around this destructive process.

 

How do you do that? Here are some tips.

 

If your pain is consistently from certain physical postures, positions, movements or activities you need to:

1.     Avoid or at least change the way that you perform these behaviours so that they become non painful.

2.      Unload the structure which is hurting with tape, bracing, sling, crutches etc. to the point that stress has been alleviated.

3.     Apply a cold pack for 10-20 minutes (check the skin every 5 minutes for adverse skin reactions) and repeat at least 6 times a day for 3- 5 days. The emphasis on cold packs is especially important towards the end of the day.

4.      Depending on the severity and the irritability of the tissue (how much stimulus causing how much pain for how long it lasts), dictates how much movements is possible. The key is to keep movement pain-free, easy and not stressful for at least 1-2 weeks to remove inflammatory chemicals and aid healing.

5.     Specific neural mobility techniques and exercises may have a profound effect on increasing nerve mobility and reducing nerve irritability and inflammation.

 

Nutritionally you need to:          

1.     Eat complex carbohydrates and low GI foods. Reduce you intake of simple, refined carbohydrates such as anything with white flour and white sugar. Refined carbohydrates cause the hormone insulin to spike which causes inflammation.

2.     Reduce Omega 6 fatty acids such as animal fats as these are pro-inflammatory and increase Omega 3 fatty acids (oily fish, flaxseed 3 to 4 times each week) as these are anti-inflammatory. The ideal ratio is 4-2:1. The current western diet is about 20:1

3.     Avoid trans-fats that contain hydrogenated oils such as many fried foods, pastries, cakes, biscuits and margarine. These are inflammatory.

4.     Reduce the intake of your food which creates an acidic environment inside your body by reducing your intake of sugar, red meat and animal products, alcohol, coffee, soft drinks) and increasing your intake of vegetables (especially green) and filtered water (2 litres per day).

5.     Avoid any food which gives an inflammatory or allergic reaction. How do you know? Listen to your body. Any time you feel lethargic, irritated, “foggy”, tired or sleepy after a meal? Do your nails tongue, hair, teeth, eyes, skin, lips, mouth, muscles and stools have any adverse changes?

6.     Eat high quality protein (>0.8 gms/kg per day).

7.     To reduce inflammation and improve healing take a daily pro-biotic and fish oil 6-9 gms/day, 1 ½ teaspoons or 8 capsules or 1 quality krill oil capsule.

8.     For natural pain relief take quercetin 600-1000mg/day Rutin, Bromelin, Curcumin.

 

Psychologically you need to:

Better manage stress so that you have a sense of control, of being in the moment, are sleeping well and are well connected with other people. 

 

It is beyond the scope of this blog to go into detail with management strategies. 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 arthritis can be painful and debilitating, this new research offers you hope. 

 

In particular, the concept of reducing nerve inflammation through nerve mobility techniques may provide a powerful treatment to restoring joint health.

 

If you are having or have had treatment for arthritis, ask your health professional to assess and treat your nerve mobility. It may just be the key to getting you better.

 

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

 

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

 

Wishing you the best of health and life.

 

Michael Hall

Director, Physiotherapist

Bodywise Health

 

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

Please note:

·       Rebates are available through your private insurance extras cover;

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

 

References available on request

 
 
Bodywise Health
364 Hampton St
Hampton, Victoria, Australia, 3188
 
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How to Rescue Your Arthritic Knee from a Knee Replacement

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Overcoming arthritic knee pain and achieving knee pain relief is one of the greatest orthopaedic treatment challenges there is. Knee arthritis is the most commonly diagnosed cause of knee pain in people over 50 and achieving knee pain relief from knee arthritis is the main reason why people seek a knee replacement (Losina et al 2012, Nguyen et al 2011).

In 2010, 25,970 total knee replacements were performed in Australia, representing a 67% increase over the past seven years and a direct cost to the health system of $2.24 billion (consisting of $900 million in hospitalisation, $8.5 million on GP visits, $2.2 million on specialist visits and $1.4 million on other practitioners).

Despite this, 15-30% of patients report no or little functional improvement in the 12 months following a knee replacement and those people who have a knee replacement too early, report dissatisfaction with their knee replacements (Paulsen 2011).

Knee osteoarthritis can be confusing and frustrating
Pain from knee osteoarthritis can range from barely perceptible to unbearable. This is especially confusing when the amount off pain reported does not correlate with the severity of change found on X-ray (Cubukou et al 2012, Schiphof et al 2013). Likewise, most people over the age of 50 have structural abnormalities consistent with osteoarthritis on MRI but only one third have pain.

The Source of Knee Osteoarthritis Pain
As the cartilage covering the surface of bones where they meet each other (i.e. joints) doesn't have a nerve supply, it is unlikely that it is a source of pain. Other sources of arthritic knee joint pain that have been suggested are:
1. the underlying bone;
2. the synovial membrane (which lines the inner cavity of the joint);
3. the cartilages (or menisci which act as cushions within the knee joint);
4. the ligaments and joint capsule (which holds the knee together); and
5. the fat pad (which sits just under the bottom part of the knee cap).

There is bad news and good news if an MRI shows that you have a horizontal cleavage meniscal tear in your knee. The bad news is that you have torn the cartilage where it has a nerve supply and this can cause immense pain and discomfort especially while sleeping.

The good news is that where there is a nerve supply, there is a blood supply which means that if the appropriate conservative treatment is given, the tear can heal, albeit slowly (it can take up to 12 months).

If you decide to have an arthroscope (partial meniscectomy), research has shown that recovery takes the same length of time, but your knee will become a lot more arthritic, a lot more quickly compared to if you just stick with physiotherapy (Sihvonen et al 2013, Katz et al 2013).

The Causes of Osteoarthritic Knee Pain that You Can Change
Osteoarthritic knee pain increases as your weight increases and as your quadriceps muscle strength decreases (Nguyen et al 2011, Amin et. all 2009, Segal et al 2010. Therefore, the two most important changes that you can make to achieve arthritic knee pain relief is to reduce your weight and increase the strength of your quadriceps muscle.

Research has shown that it is not only knee pain but the fear of pain that can reduce your quadriceps muscle strength (Hodges et al 2009). Furthermore, middle aged people who have decreased quadriceps strength report increased knee pain and MRI scans show accelerated osteoarthritic changes in the knee (Wang et al 2012).

Incorrect knee joint alignment, poor quadriceps muscle control, faulty movement and excessive loading all lead to excessive or abnormal forces being placed upon the structures and tissues of the knee. This can lead to pain which further inhibits your quadriceps muscle strength thereby perpetuating and accelerating your knee degeneration. (Hayashi et al 2012, McConnell and Read 2014).

How to Achieve Arthritic Knee Pain Relief
For treatment to be successful, it must therefore involve:

  1. Reducing your knee inflammation and pain;
  2. Unloading the painful knee structures and tissues;
  3. Promoting healing
  4. Correcting joint alignment;
  5. Improving muscle control and strength especially that of the quadriceps muscle;
  6. Optimising your everyday postures and movements (e.g. walking) so that the most ideal forces possible are placed on your knee joint.
  7. Reduce your knee pain and inflammation

Inflammation is a breaking down process. It must therefore be limited for healing to take place. If you experience constant, throbbing pain and your knee feels warm apply cold packs (wrapped in a damp thin cloth) to your knee for 15 minutes at least 6 times a day (be sure to check your skin every 5 minutes for adverse reactions). Do this until the warmth, constant pain, night pain and morning stiffness in your knee recede.

Or if your knee pain is worse at the end of the day, apply a cold pack 3 or 4 times on the hour before you go to bed. This will help you sleep better and awake in the morning with less knee stiffness.

Unload your painful knee structures and tissues
You can unload your painful knee structures and tissues by:

  1. Reducing your weight. Research has indicated that this is the number one thing that you can do to achieve relief from arthritic knee pain;
  2. Avoiding painful positions, movements and activities (e.g. prolonged standing and walking);
  3. Using orthotics, wearing supportive shoes with good shock absorption, walking on softer surfaces (avoiding concrete, tiles or hardwood floors) and sitting down frequently (e.g. every 20 minutes);
  4. Taping and bracing your knee for added external support;
  5. Walking with elbow crutches for up to 2 weeks to enable reduce inflammation to recede and facilitate healing and repair.

Promote healing
To accelerate healing and optimise your knee's repair, employ "hands on" freeing up techniques, Bodyflow therapy (which improves circulation), Lipus Ultrasound (which stimulates the laying down of tissue), heat therapy (which increases activity) and easy pain-free movement, all of which have been proven to assist with healing.

Correct Joint Alignment
Your knee cap and knee joint alignment can be corrected by using "hands on" techniques to free up stiff joints and loosen tight soft tissues, applying tape or bracing to hold joints in correct alignment and then through targeted exercises that strengthen weak muscles and stretch tight, stiff soft tissues.

Improve the Control and Strength of Your Leg Muscles (Especially your Quadriceps)
Rehabilitation programs which improve the stability and strength of your core, hip and knee and which optimise the way that you move, have been shown to reduce knee pain for up to 12 months following physiotherapy. These programs have also been shown to improve the quadriceps muscle tone as well as the position of the knee cap on MRI scans (McConnell and Read 2014) indicating an increase in quadriceps muscle strength and therefore an improved dynamic stability of the knee.

Optimising your everyday postures and movements (e.g. walking)
Improving your balance and increasing your core, hip and knee muscle strength can ultimately lead to an improvement in everyday activities such as standing, rising from sitting, getting in and out of cars and walking.

And by "normalising" the forces on your knee during your everyday activities, the abnormal or excessive forces that cause the break down and irritation of the knee joint tissues and structures are eliminated.

Ultimately, these rehabilitation programs may help you avoid the need for a knee replacement or at the very least help improve your muscle function, mobility and quality of life thereby delaying your need for a knee replacement. They will also give you the best chance of an optimal outcome if you do have to have a knee replacement.

The evidence is clear. Specific physiotherapy treatment is a proven, safe, effective and lower cost alternative in helping you to attain knee pain relief from arthritis.

So if you do suffer from arthritic knee pain and you want the best, safest, most empowering way of overcoming your knee pain, you should consider a physiotherapy treatment program as your first option.

We might just be able to save our government's bottom line and you a lot of time and heartache.

If you have physical pain and would like a solution to your problem, please call 1 300 BODYWISE (263 994) for your FREE assessment and advice.

Until next time, Stay Bodywise.

Best Wishes,

Michael Hall

Physiotherapist, Director Bodywise Health

Please note: 

* Rebates are available through your private insurance extras cover;

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

References
1. Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME, Rome BN, Chen SP, Hunter DJ, Suter LG, Jordan JM, Katz JN. 2012 Lifetime risk and age of diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res
2. Nguyen US, Zhang Y, Zhu Y, Niu J, Zhang B, Felson DT. 2011 Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data. Ann Intern Med. Dec 6;155(11):725-32
3. Access Economics, 2007. Painful Realities: The economic impact of Arthritis in Australia in 2007
4. Paulsen MG, Dowsey MM, Castle D, Choong PF 2011 Preoperative psychological distress and functional outcome after knee replacement. ANZ J Surg. Oct;81(10):681-7
5. Cubukcu D, Sarsan A, Alkan H. 2012 Relationships between Pain, Function and Radiographic Findings in Osteoarthritis of the Knee: A Cross-Sectional Study. Arthritis.;2012:984060. doi:10.1155/2012/984060
6. Schiphof D, Kerkhof HJ, Damen J, de Klerk BM, Hofman A, Koes BW, van Meurs JB, Bierma-Zeinstra SM Factors for pain in patients with different grades of knee osteoarthritis. Arthritis Care Res 2013;65(5):695-702.
7. Guermazi A, Niu J, Hayashi D, Roemer FW, Englund M, Neogi T, Aliabadi P, McLennan CE, Felson DT. 2012 Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). BMJ. 29;345:e5339.
8. Javaid MK, Lynch JA, Tolstykh I, Guermazi A, Roemer F, Aliabadi P, McCulloch C, Curtis J, Felson D, Lane NE, Torner J, Nevitt M. 2010 Pre-radiographic MRI findings are associated with onset of knee symptoms: the most study. Osteoarthritis Cartilage;18(3):323-8.
9. Felson DT, Parkes MJ, Marjanovic EJ, Callaghan M, Gait A, Cootes T, Lunt M, Oldham J, Hutchinson CE. Bone marrow lesions in knee osteoarthritis change in 6-12 weeks. Osteoarthritis Cartilage. 2012;20(12):1514-8.
10. Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TL;Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med. 2013;369(26):2515-24
11. Katz JN, Brophy RH, Chaisson CE, de Chaves L, Cole BJ, Dahm DL et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. 2013;368(18):1675-84.
12. Dragoo J L, Johnson C, McConnell J 2012 Comprehensive Treatment of Disorders of the Infrapatellar Fat Pad Sports Med.1;42(1):51-67
13. Clements KM, Ball AD, Jones HB, Brinckmann S, Read SJ, Murray F. Cellular and histopathological changes in the infrapatellar fat pad in the monoiodoacetate model of osteoarthritis pain. Osteoarthritis Cartilage. 2009;17(6):805-12.
14. Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT: Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. Arthritis Rheum 2009,60:189-198.
15. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, Nevitt M, Lewis CE: Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage 2010,18:769-775.
16. Hodges PW, Mellor R, Crossley K, Bennell K. 2009 Pain induced by injection of hypertonic saline into the infrapatellar fat pad and effect on coordination of the quadriceps muscles. Arthritis Rheum. 15;61(1):70-7
17. Wang Y, Wluka AE, Berry PA, Siew T, Teichtahl AJ, Urquhart DM, Lloyd DG, Jones G, Cicuttini FM. Increase in vastus medialis cross-sectional area is associated with reduced pain, cartilage loss, and joint replacement risk in knee osteoarthritis. Arthritis Rheum. 2012;64(12):3917-25.
18. Hayashi D, Englund M, Roemer FW, Niu J, et al Knee malalignment is associated with an increased risk for incident and enlarging bone marrow lesions in the more loaded compartments: the MOST study. Osteoarthritis Cartilage. 2012;20(11):1227-33
19. McConnell J, Read J. 2014 OA-related knee pain: MRI changes following successful physiotherapy – a case series. Rheumatolgy S16: 008. doi:10.4172/2161-1149.S16-008

 

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Tendon Recovery Update - The Latest Research

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There is no doubt that tendon problems can be among the most frustrating injuries for people. Because tendons attach muscles to bone, tendon problems can therefore interfere with movements all over your body from lifting your arm (Rotator Cuff tendinopathy), to holding an object (tennis elbow) to walking (hip tendinopathy), to squatting (knee tendinopathy) and even to pushing off your foot (Achilles tendinopathy).

However, new research from Sydney and Glasgow is uncovering what is really going wrong with tendons and how well designed physiotherapy can deliver better outcomes than surgery.

What is tendinopathy?

Tendinopathy literally refers to tendon pain. It can be extremely debilitating, with at least 40% of all general practitioner consultations involving a tendon problem. Historically, tendon problems haven't been treated very well because the underlying disease process wasn't very well understood.

Who is at risk?

The typical person who tends to suffer from tendon problems is a person in their mid 40's to 50's who is moderately active. Initially, they experience pain following an activity which then becomes more constant often waking them from sleeping at night and worse at the end of the day.

With probing questions, it is often discovered that the pain is related to a repetitive movement. Classic examples of repetitive movement as the cause of tendinopathies include prolonged swimming, playing guitar or painting for shoulder tendinopathies, using the mouse, pruning and knitting for elbow tendinopathies and walking or running for Achilles tendinopathies.

The latest research and the latest discoveries

We've known for 30 years that instead of the tendon being pristine, white, type I collagen which is as strong as steel, the injury has transformed it into the more ragged, greyish, weaker and painful type III collagen. The only problem is that we haven't known why, until recently when it was discovered that the switch for dialing up or down type III collagen becomes dis-regulated.

What the recent research has shown, is that it is mechanical tension or specific strengthening exercises that can re-regulate this switch. The question is how much and how often should exercises be performed for optimal adaptation. Too little and the tendon degenerates (use it or lose it). Too much and the tendon breaks down further.

Professor Jill Cook at Latrobe University has shown that isometric exercises (strengthening exercises where the muscle develops tension but there is no movement of the joint) performed initially have been shown to reduce tendon pain and begin the process of remodeling the tendon.

What you need to do to get better and return to the activities that you want to do.

However to return to the sports and activities that you want to do, requires a whole lot more than just strengthening the tendon in an isolated way. Yes, you need to strengthen the tendon so that it can tolerate forces above and beyond the stresses that it will be placed under. But more than that, you need to strengthen associated muscles, correct sports and functional technique and finally you need to improve the tendon's endurance, so that it can tolerate these forces over and over again.

Failure to complete this extensive rehabilitation will result in just short term pain relief from your pain. It is simply physics. You cannot load a tissue beyond what it has been trained to tolerate and expect it not to break down.

If you suffer from shoulder, elbow, hip, knee or ankle tendon problems and would like some help to get rid of your pain and to return to activities that you love to do, call us here at Bodywise Health on 1 300 BODYWISE (263 994) for a Complimentary, No Obligations Assessment and Recovery Action Plan.

In your Complimentary, No Obligations Assessment session you will learn what the source and cause of your pain is and develop a Recovery Action Plan that will deliver you the best results in the shortest amount of time.

You will also discover:

* How to optimise the phase of healing;
* How to accelerate healing;
* How to get the best, strongest repair;
* How to perfect the performance of every day and sporting activities so that you achieve more efficient, effective results;
* How to have more energy;
* How to prevent the reoccurrence of your injury.
* What improvement to expect and when so that you can monitor your recovery and know that you are on track to achieve your goals in a forecast timeline.

If you have not achieved results in the past and you want to overcome your injury and pain once and for all so that you can get back to doing the things that you love to do, call us here at Bodywise Health on 1 300 BODYWISE (263 994) and take the first step to getting better, moving on from your pain and enjoying life.

We look forward to helping you.

Until Next Time, Stay Bodywise

Michael Hall
Physiotherapist
Director Bodywise Health

Reference:
The Health Report, Norman Swan, ABC

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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Bulging Disc? Sciatica? Lower Back Pain?Here's how to Achieve Lower Back Pain Relief.

back-pain-mainJust hearing the words bulging disc, herniated disc or sciatica is enough to strike fear into the hearts and minds of all people. And rightly so, as a bulging disc or disc herniation causing sciatica can be an extremely debilitating and painful condition and if not treated correctly, can have a most disabling effect on your life. 
When describing this condition, it is not uncommon to hear people say that they have a "slipped disc" and have put their "back out". Whilst this is an incorrect over-simplification of this condition, it does suggest that something has slipped 'out' and needs to be pushed back "in". What this refers to is the inter-vertebral disc which can be a potent source of low back pain as they bulge, tear and split.

So what is a Bulging Disc or Herniated Disc?
Except in the cases of paraplegia or quadriplegia, it is impossible for a person to 'put their back out' as the vertebral bodies of the spine are held together by an inter- vertebral disc. This disc acts as a cushion and by deforming in all directions allows the spine to bend in all directions. 

In the middle of this disc is a paste/gel like substance called the nucleus pulposus. This substance acts as a fulcrum for movement and as the disc deforms, it evenly distributes the forces throughout the disc. Enveloping this nucleus is a fibrous casing called the annulus fibrosis. 

Research has shown that there are only two degrees of motion at each level between the 1st and 5th lumbar vertebrae and five degrees between the 5th lumbar and 1st sacral vertebrae. (Sahrmann 1997). Movement beyond this has been shown to result in tearing of the disc. Consequently, repeated minor trauma such as with bent, rotated postures may cause circumferential fissures in the annulus. As only the outer layers of the annulus receive a nerve supply, for a disc to become painful, a lesion must involve the outer third of the annulus. These defects then provide a potential pathway for the nucleus to seep into, causing the disc to bulge, split, tear and seep out. 

By a person's 30's, the nucleus pulposus tends to dry out and consequently true herniations tend to occur in people in their 20's (Bogduk and Twomey 1991). However, disc bulging in the older person can occur due to degeneration of the nucleus and failure of the annulus. Again this pathology is usually associated with repeated poor postures and movement patterns and can lead to spinal canal stenosis, an important source of low back pain. 

Incidence
The most common age for disc prolapses to occur is in the 25 to 45 year old age group. It more common in males at a ratio of 3:2 with the most common site for prolapse being between L5/S1 (46.4%) and the L4/5 disc being the most common transitional area (40.4%).


Other influencing factors leading to disc prolapse include;
1. Poor posture and movement patterns, leading to increased joint strain, wear and tear and eventually fatigue. 
2. Poor equipment and work station setup.
3. Congenital ill development - e.g. excessive spinal curvature
4. Trauma 
5. Joint malalignment 

Signs and Symptoms
The size, severity and direction of the disc injury as well as the associated structures affected, will determine the presenting signs and symptoms. Herniated discs may occur suddenly or gradually, as a result of a single major traumatic event or as the result of some minor event. Stories such as "I bent over" or "I reached forward" are not uncommon and are often associated with a dull ache or knife like pain either in the midline or off to one side. 

The lower back pain may initially be intermittent, but is worsened by sitting, bending and coughing/sneezing and often disturbs sleep. Generally, it is confined to the lower back region, but later may radiate into both or more often one leg. 

The distance of radiation is more indicative of the severity of injury rather than the structures involved and whilst irritation of the sciatic nerve cause pain, direct pressure on the sciatica nerve results in numbness, tingling, weakness and loss of reflexes. 

X-ray Features 
Whilst x-rays do not show soft tissue damage, they may indirectly show the effects of a prolapsed disc, by the presence of deformity, joint mal-alignment and flattening of the disc. Myelography, CT or MRI scans may also reveal a disc bulge or herniation.

Differential Diagnosis
Whilst pain associated with facet joint strains tends to be specific and isolated, disc prolapses pain tends to be more vague and diffuse. Bending which tends to aggravate disc prolapses tends to relieve pain associated with a spinal canal stenosis or spondylolythesis. In contrast, arthritic movements tend to be limited in all directions.

Treatment
Treatment of acute disc injuries will vary with the severity and extent of the person's symptoms. A bulging disc with or without sciatic nerve involvement, treatment may include short term bed rest, electrotherapy, traction, graduated mobilization as well as a prescription of extension exercises and sometimes the use of taping or a back brace. These may be used in conjunction with anti-inflammatory medication to provide further relief. 

It is important to avoid any movements or positions which aggravate your pain. McKenzie exercises may also be given along with 'hands on' and dry needling techniques to assist with pain reduction or to restore the mobility and promote an environment of healing.

Tissue healing may be further promoted through the use of electrotherapy, massage, joint and sciatic nerve mobilisation as well as back pain exercises to give sciatica pain relief. Spinal mobilisation and manipulation be combined with precise stretching and trunk stabilisation exercises to normalise spinal mobility and core control. 

As improvement continues, stabilisation is progressed from slow, controlled contractions to faster and more automated activities to more approximate lifestyle conditions. Both strengthening and aerobic conditioning may then be built on top of this stabilisation base to give maximum protection against re-injury as well as to facilitate a higher level of physical performance. 

Finally, lifestyle components such as work / home environments, equipment, as well as habitual movements and postures must also be addressed if optimal function is to be achieved and injury recurrence is to be minimised. 

I hope that this helps.

 
Until next time, Stay Bodywise,
 
Michael Hall
Director
Bodywise Health

 

 
To learn more as to how Bodywise Health can help you overcome back pain or for 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 doctor.   For more information, please call Bodywise Health on 1 300 BODYWISE (263 994).
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Is Your X-Ray or Scan Doing You More Harm Than Good

Image result for X Ray, CT AND MRI Scans

X-rays, ultrasound, CT and MRI scans can be very valuable for identifying serious medical conditions such as fractures, spinal cord injuries and other specific lesions. However, once "serious problems" are ruled out by a radiologist, evidence shows that minor findings may not just be of no value in helping to explain the majority of aches and pains, they may be psychologically harmful especially when they tell patients that they have arthritis, degenerative disc disease, disc bulges, tendon tears and more.

Everyday thousands of Australians become confused and distressed by medical imaging that doesn't match the source or cause of their particular pain or problem. These people have been shown to have more doctor's visits, more lasting pain, more disability and a lower sense of welbieng.1, 2, 3

Here are a few important facts regarding medical imaging that you must be aware of to prevent yourself being fooled by your X-Ray or diagnostic scan.

Lumbar Spine - Lower Back
It is well established that most imaging findings, particularly degenerative changes, correlate poorly with clinical presentation.

Studies have shown that lumbar disc degeneration is present in 40% of individuals under the age of 30 and present in over 90% of people between the ages of 50 to 55.8

Another study showed that amongst healthy young adults aged 20 to 22 years with no back pain, 48% had at least one degenerative disc and 25% had a bulging disc.9

Leading physicians at the department of Neurosurgery in California strongly recommend AGAINST the routine use of MRI for low back pain as they have NO LINK between degenerative changes seen on x-rays or MRI's and low back pain.10

Other research findings include:

1. Individual neuro findings on MRI (disc herniation, root compression etc.) don't provide definitive link to LBP (Endean et al. 2011; Shambrook et al. 2011)

2. MRI does not improve clinical outcomes in the absence of red flags (Chou et al. 2009)

3. Early imaging does not positively impact clinical outcomes (Graves et al. 2012)

4. Inappropriate imaging can lead to misdiagnosis, inappropriate management decisions, potentially unnecessary surgery, poor outcomes and greater financial, social, psychological and physical costs (Flynn et al. 2011; Haldeman et al. 2012)

5. Spine MRI in primary care often leads to surgical assessment - yet MRI cannot discriminate surgical vs. non-surgical cases (You et al. 2012).

Translation: Do not panic if your x-rays shows "problems" with your discs; they simply are normal changes that occur from the age of 20 onwards.

Thoracic Spine - Mid / Upper Back
MRI studies of healthy adults with no history of upper or low back pain found that 47% had disc degeneration , 53% had disc bulges and 58% had disc tears in their thoracic spine. Amazingly, 29% of these healthy young people had a disc bulge that was actually deforming and pressing on the spinal cord, yet they had no signs or symptoms. 6,7

Translation: Do not panic if your x-ray or MRI shows "problems" with your discs; they are simply common and NORMAL findings.

Cervical Spine - Neck
An MRI study of healthy adults and seniors found that 98% of all men and women with no neck pain had evidence of "degenerative changes" in their cervical discs.

A 10 year study compared the MRI's of healthy people to those with whiplash injuries. Immediately and 10 years later both groups had similar MRI's with 75% having disc bulges.5

There was also a recent study where they MRI'd the SAME patient in 10 facilities and got COMPLETELY different reports from all of them - not good!

Translation: The majority of all healthy adults get neck degeneration (arthritis and disc bulges meaning they are a NORMAL aging process! Therefore, neck arthritis and mild to moderate disc bulges can only be a reasonable explanation of your neck pain if they match your clinical examination.

Shoulder
MRI studies of adults who have no shoulder pain show that 20% have a partial rotator cuff tear and 15% have a full thickness tear. In addition, in those 60 and older with no shoulder pain or injury, 50% (half) of them had rotator cuff tears on their MRI's that they didn't know about.16

A study of professional baseball pitchers showed that 40% of them had either partial or full thickness tears yet had no pain while playing and remained pain free even 5 years after the study.17

Translation: Do not panic if your ultrasound and/or MRI shows a rotator cuff tear; it is not necessarily associated with your shoulder pain!

Hip
There is only a weak association between joint space narrowing as seen on x-rays and actual symptoms.11

In fact, one study showed that 77% of healthy hockey players who had no pain, had hip and groin abnormalities on their MRI's.12

Translation: Do not panic if your x-ray or MRI shows cartilage tears or narrowing; it is not a sign of permanent pain or disability.

Knee
Studies have shown that when x-rayed, up to 85% of adults with no actual knee pain have x-rays that show knee arthritis. This means that there is little correlation between the degree of arthritis seen on x-rays and actual pain.13

In fact, one study showed that 48% of professional basketballers had meniscal (cartilage) "damage" on their knee MRI's.

Translation: Do not panic if your knee x-ray or MRI shows degeneration, arthritis or mild cartilage tears; it is NORMAL!

Ankle
Although there is an association with plantar fasciitis and heel spurs, it should also be known that 32% of people who have no foot or heel pain have a heel spur visible on x-ray.15

Translation: One third of all people have a heel spur and yet have no pain.

After reviewing this research you might be thinking that x-rays and diagnostic scanning are useless in identifying sources and causes of the majority of injuries and diseases. Not so. Diagnostic imaging techniques are valuable tools in assisting with diagnosis and healthcare management.

However, x-rays and scans are just one set of tools that provide unique insights that must be considered in the wider context of physical assessment and evaluation, as well as the social, psychological, nutritional status of a person. Only when all these factors have been considered, can an optimal healthcare management plan be devised and implemented to achieve the best health outcomes possible for you.

If you have an injury or pain that you would like to get better as quickly and completely as possible, please call Bodywise Health on 1 300 bodywise (263 994) and receive a no obligation, complimentary injury assessment and advice.

In this session, you will discover the source and cause of your problem as well as the number one thing that you can do to help yourself get better.

References for Diagnostic Imaging of Musculoskeletal Injuries

1. Kendrick D, et al. The role of radiography in primary care patients with low back pain of at least six weeks duration: A randomised (unblended) controlled trial. Health Technol Assess.2001: 5(30);1-69.

2. Ash LM, et al. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR. Am. Neuroradiol. June 2008. 29 (6):1098-103.

3. Modic MT, et al. Acute low back pain and radiculopathy: MR imaging findings and their prognostic role and effect on outcome. Radiolog. 2005 Nov; 237 (2) 597-604.

4. Okada E, et al. Disc degeneration on MRI in patients with lumbar disc herniation: comparison study with asymptomatic volunteers. Eur. Spine J. 2011 Apr;20(4):585-91.

5. Matsumoto M, et al. Prospective 10 year follow-up study comparing patients with whiplash associated disorders with asymptomatic subjects using magnetic resonance imaging. Spine. (Phila Pa 1976) 2010. Aug 15;35(18):1684-90.

6. Matsumoto M, et al. Age related changes of thoracic and cervical intervertebral disc. Spine. (Phila Pa 1976) 2010. Jun 15;35(14):1359-64.

7. Wood KB, et al. Magnetic resonance imaging of the thoracic spine. Evaluation of asymptomatic individuals. J Bone Joint Surg. Am 1995 Nov;77(11): 1631-8.

8. Cheung KM, et al. Prevalence and pattern of magnetic resonance imaging changes in a population study of one thousand forty three individuals. Spine. (Phila Pa 1976) 2009. April 10;34 (9):1934-40.

9. Takatolou J, et al. Prevalence of degenerative imaging among young adults. Spine. (Phila Pa 1976) 2009. Jul 15;34(16):1716-21.

10. Chou D, et al. Degenerative magnetic imaging changes in patients with chronic low back pain: A systematic review. Spine. (Phila Pa 1976) 2011. Oct 1;36 (21 Suppl):S43-53.

11. Chu Miow Lin D, et al. Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: A systematic review. Osteoarthritis Cartilage. 2011 May;19(5):543-9.

12. Silvis L, et al. High prevalence of magnetic imaging findings in asymptomatic collegiate and professional hockey players. Am J. Sports Med. 2011 Apr;39(4): 715-21.

13. Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskel. Disord. 2008 Sep 2;9:16.

14. Kaplan LD, et al. Magnetic resonance imaging of the knee in asymptomatic professional basketball players. Arthroscopy. 2005 May;21(5):557-61.

15. Johal KS, Milner SA. Plantar fasciitis and the calcaneal spur. Fact or Fiction? Foot Ankle Surg Am. 2012 Mar; 18(1):39-41.

16. Sher JL et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995 Jan;77(1):10-5.

17. Connor PM, et al. Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: A 5 year follow up study. Am J. Sports Med. 2003 Sep-Oct;31(5):724-7.

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The Truth About How to Fix Your Tendon Problems

clinical pilates brightonElbow tendonAchilles TendonKnee Tendon

Busting Myths for Tendon Problems

Myth One - Eccentric exercise is the best exercise for rehabilitating tendon.

Whilst eccentric exercise (strengthening exercise where the muscle is lengthening) is the most researched, evidenced based program that is used, world renowned tendon specialist Professor Jill Cook from Latrobe University states that upon reflection, eccentric exercise by itself is deficient because it doesn't address the specific requirements of a person. They may be OK for the middle aged male runner, but they aren't that great for the younger sprinter or for the older person.

More importantly, eccentric exercise doesn't address the strength deficits of the muscle or of the body in general and they don't address the new research findings of the brain's and nervous system's deficiency in activating the muscle. Therefore, eccentric exercises by themselves are quite deficient in being able to restore full function.

What is the best treatment program for tendon problems?
The best treatment for tendon problems is really tailoring a program that best matches each person's individual wants, needs and requirements. For example, a young sprinting athlete with a hip tendon pain will have a different program to an older woman with the same condition.

Likewise a shoulder tendon problem will have a different program to an elbow tendon or an Achilles tendon problem. And even further from this, an Achilles tendon problem where the pain is in the mid portion of the tendon, the same as if the pain is at the insertion (attachment) and you can't treat either the of these the same as if the problem is in the covering of the tendon (peritendon).

This is why people need to be treated so individually. The purpose of treatment is to restore function to the level that a person wants. Anything after this is a bonus.

What are the key principles in tendon treatment?

The key principles include:
1. Promoting muscle strengthening which can only be achieved with strengthening exercises that involve both shortening and lengthening of the muscle. If you have good muscle strength, this will protect your tendons as well as other structures;

2. Having the ability to restore and release energy in the tendon if you are a higher level athlete;

3. Ensuring that the whole body is working efficiently and effectively with good mechanics;

4. Correcting faulty functional movement patterns.

What stages are involved in tendon rehabilitation?
To restore people back to high level function is a four stage process. For a person who doesn't need to meet high level athletic demands, they will not need to go through all four stages.

Stage 1 involves using isometric exercise (strengthening exercise where the muscle is contracting but there is no movement at the joint) to reduce pain and the brain's inhibition to activating muscle;

Stage 2 involves implementing a good strength program for the muscle/tendon unit as well as all other associated parts of your body. For example, the higher up your leg that you go, the more that you need to restore below the problem. If you have an Achilles problem, it is mainly calf that needs to be restored. If you have a knee tendon problem then the quadriceps and calf will also need to be restored. And finally, if you have a hip tendinopathy, it is glutes, quadriceps and calves that need to be restored.

In particular, you need to restore the strength of your anti-gravity muscles and then depending on their activity level, you need to restore the spring. As the tendon act like springs, you need to make them work again especially with the faster the movements and energy storage movement.

Stage 3 involves adding to this is endurance. For example, if someone wants to play football, they not only need to have a great general body strength and control and a great set of springs, they also need to spring repeatedly and therefore their tendons must have great endurance. It is this lack of endurance, or the capacity of the tendons to tolerate prolonged stress, that failure occurs.

Stage 4 involves adding spring strength and endurance. This is why tendons often take so long to get better. They often present extremely debilitated and damaged. There often has been long term pain with the tendons being robbed of their energy, endurance and muscle strength and bulk. And all of this needs to be restored, before the tendon can be made resilient enough to cope with the stresses that a person want to place upon the tendon in the activities that they want to get back to.

People who leave treatment early will often find that their pain will return in a couple of weeks because the tissue is only as good as the load that is placed upon it. And this is the same for tendon, muscle and bone. This means that if tissue hasn't been restored to a capacity that is needed in an activity or sport it will fail again. It's just physics. You cannot continue to load a tendon greater than what is has been trained to do. It isn't rocket science and just self-evident.

Physiotherapy should the first treatment of choice because tendons need exercising and correct loading. Physiotherapy shouldn't come after medication, injections or other intervention.

Myth Two - Tendon problems always involve inflammation

Tendon problems were originally thought to be an inflammation of the tendon (i.e. Tendinitis) in the 1970's until a fantastic study showed that tendon pain was primarily due to degeneration rather than inflammation.

Of course, like any other tissue, there will be some inflammatory markers and there will be some inflammatory cells because it's a tissue that is injured. However, inflammation is not the driving process. It is not the thing which is creating the pain and it is not the thing which is creating the ongoing pathology.

What causes the pathology is due to the over-loading of the tissue either on a prolonged or a short term basis. What causes the pain seems to be the tendon cell releasing pain chemicals.

If a person has an acute injury and ice doesn't help, then don't waste your time putting ice on the injury. Spend your time doing exercise. If ice does help, this is an indication that the injury probably has some peritendon (sheath covering the tendon) involvement. Therefore, ice and anything else which you perceive to be helping can be used along with exercise that has the correct loading. The evidence however, is that rest, ice, compression and elevation won't help you.

Myth Three - Once the tendon is pain free and you have returned to sport you don't need to do your exercises any more.

It is important that you understand that even if your tendon is pain free and you have returned to sport that the pathology in the tendon is still there.

Tendons don't heal even if the pain goes away. Once a tendon, always a tendon. If you do the right things your tendon will stay pain free. If you don't do the right things, your tendon will become painful again.

In addition to this, your brain is still inhibiting the activation of your muscles, because it is worried that you are going to re-injure your tendon again. Consequently, this means that if you return to sport and you stop your strength training, your muscle strength will decrease markedly if you stop your exercises and you will be prone to re-injuring yourself.

To prevent re-injury, it is important that you continue with your strength training exercises at least twice each week for at least a year following full recovery and then you may have a chance to give up the exercises.

For elite athletes they need to continue with their strength exercises 3 times a week for the rest of their careers. This is because these strengthening exercises are acting like an insurance policy. If you can stay strong, you keep your tissue (muscle and tendon) capacity up, you will be less likely to get into trouble again.

Because of your brain protective inhibition on your muscles and tissues, it means that when you have been injured, when you return to sport, you won't run, jump, twist, turn or just move quite the same way that you did before your injury. Therefore, the first season following a major injury is a building season. Following this you will need to do a really good pre-season and the second season back will be a "cracking" season.

It can take this long to be able to use your tendon as a spring and be sure that it is not going to cause your pain.

Myth Four - The tendon will get better quickly

It is critically important that you are educated regarding your tendon pathology.

You need to see how much swelling there is, how much muscle bulk you have lost, how your tendon store energy and how badly you hop.

You need to understand how your tendons react to pathology and how pain is caused and how we need to build capacity.

You need to understand that once a tendon, always a tendon and though you can become pain free and you will be able to return to sport, we want you to be able to play as well as you can.

You might be a bit sore the day after sport, but you will be able to train the day after this.

Understand that unless you are prepared to buy in to a 3 to 6 months rehabilitation process (and sometimes longer), there is no point in starting. You need to understand how long it will take and why, so that you can work with your tendon and your body to achieve the best outcome. Unfortunately there is no quick fix.

If you have tendon problem and you want to get better as quickly as possible, call Bodywise Health on 1 300 Bodywise (263 994) for a no obligation, complimentary assessment and advice.

You have nothing to lose except your pain!

Until next time, stay Bodywise,

Michael Hall
Director
Bodywise Health

Reference
Professor Jill Cook; Busting Tendon Myths Conference; San Diego 2016

 

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Why female athletes are more prone to knee injuries and what you can do about it

physiotherapy in brighton

What a wonderful start to the Women's Australian Rules Football season. It's been fortunate that the injury toll has been keep largely in check. There have been a few exceptions, namely:

  1. Natalie Plane from Carlton with her high-grade ankle sprain
  2. Meg Downie from Melbourne with a hamstring rupture
  3. Stephanie De Bortoli also from Melbourne with an Achilles tendon tear
  4. Brianna Green, a Fremantle player fractured her collarbone


There have been two major knee injuries reported to have occurred during the season so far. Sophie Armitstead with a meniscal tear of the same knee she's previously had an ACL reconstructed and Kim Mickle who ruptured her ACL.

But what is this 'ACL'?
The Anterior Cruciate Ligament is a rope-like structure that supports your knee from the inside. In some ways, it is the last structure that prevents your thigh bone and leg bone separating during not only high force activities but also day to day activities, like walking down stairs. In addition to the structural support offered, it is also considered to give information to the brain about how you are moving from the stretch and pull it undergoes as you move. Ideally, the joint and ligament is protected by strong muscles around the joint that can absorb most the force.

What puts the ACL at risk?
Somethings are out of our control, like the weather. There have been some weather conditions, that lead to a dry field, that have been seen to increase the risk of an ACL injury1.

Regrettably being older or having a previous knee injury also increases the risk of an ACL injury.

A higher grade of football was noted to contribute to an increased risk, but these players were also generally older and had previous injuries.

Gender is also a very interesting element of ACL risk. It has been found that females have an increased risk of ACL ruptures in several sports. These sports include wrestling (4 times the risk, compared to males), basketball (over 3 times the risk, compared to males), soccer (around 2.5 times the risk, compared to males), rugby (nearly 2 times the risk, compared to males) and lacrosse (only slightly higher risk)2. That study was done before the Women's AFL took off, so it did not include females playing AFL as a comparison. It was also interesting to see that AFL had similar ACL injury rates to soccer and basketball.

Fortunately, there are somethings that we can do to help reduce the risk. Increased weight and the associated higher Body Mass Index (BMI) have also been reported as putting the ACL at more risk of a rupture1. So, eating healthy and maintaining a good balance of regular physical activity has yet another advantage!

What should I do?
Most ACL injuries in AFL matches occur without contact. This would suggest that there are elements that could be worked on to reduce the risk of an ACL rupture.

Fortunately, research has backed this up3. Specific movement strategies and muscle groups have been identified as areas that players can work on to effectively reduce their risk of rupturing their ACL3.

If you are an AFL player or play one of the sports mentioned above, it would be worthwhile booking an appointment with a Bodywise Health Physiotherapist to assess your strength and movement patterns.

This allows the physiotherapist to prescribe an individualised exercise program aimed at reducing your risk of an ACL rupture and the expensive surgery and rehabilitation that goes along with it.

For further information on how you can prevent knee injuries or for a FREE assessment, please call 1 300 BODYWISE (263 994).

Until next time, stay happy and be Bodywise,

Michael Hall
Director
Bodywise Health

References

  1. Orchard, John et al. "Intrinsic And Extrinsic Risk Factors For Anterior Cruciate Ligament Injury In Australian Footballers". The American Journal of Sports Medicine 29.2 (2001): 196-200. Web. 3 Mar. 2017.
  2. Prodromos, Chadwick C. et al. "A Meta-Analysis Of The Incidence Of Anterior Cruciate Ligament Tears As A Function Of Gender, Sport, And A Knee Injury-Reduction Regimen". Arthroscopy: The Journal of Arthroscopic & Related Surgery 23.12 (2007): 1320-1325.e6. Web.
  3. Cochrane, Jodie L. et al. "Characteristics Of Anterior Cruciate Ligament Injuries In Australian Football". Journal of Science and Medicine in Sport 10.2 (2007): 96-104. Web.
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The Truth About Back Surgery

low-back-pain

Back pain – it can rip your life away from you making your every position, movement and activity excruciatingly painful beyond your imagination. You can’t sleep. Dressing yourself is difficult if not impossible and going to the toilet can be agonizing. The constancy of your pain can wear you down to the point where your whole world is consumed by “the pain”.

If that’s not enough the confusing array of information, advice and treatment options offered by often well-meaning people can often compound your sense of disillusionment and powerlessness.

Everyone you speak to has a different opinion or magic cure. Friends will often tell you about their “guru” therapist that you must see. Therapists will give you many and varied diagnoses and treatments all promising to “fix” your problem. Doctors may send you for X-rays, CT scans and MRI scans but often the long words of these technical reports heightens your fears that something is seriously wrong and that hope of a cure for your pain is fading.

And then under the advice of your treating health professional you undergo any number of different treatments including nerve blocks, epidurals, radiofrequency neurotomies, prolotherapy and intradiskal electrothermal therapy, unbeknown to you, that most of these treatments offer at best between 30-60% of short term pain relief. 1,2,3,4

Is it no wonder that Australia is following America’s lead with spinal surgery increasing at 10% a year?5 In America, experts estimate that nearly 600,000 people opt for back operations each year. Yet, a new study in the journal Spine shows that in many cases that even surgery can backfire, leaving patients in more pain.

Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.

After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.

The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.

Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.

27 million adults with back problems

A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physiotherapy, pain management, chiropractor visits, and other non-invasive therapies, the majority pays for spine surgeries.

Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there has been an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.

For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. The indications for spinal surgery include:

• Nerve root compression resulting in persistent toileting problems, leg pain or numbness, tingling and muscle weakness;
• Persistent pain due to instability of a single intervertebral segment.

“But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”

Despite the fact that over 250,000 lower back fusions are performed every year in the USA, there is no evidence to support this operation for discogenic back pain.6,7

Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.

“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”

Source of pain is often hard to pinpoint

The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.

Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says. And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.

In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent.

Proven strategies for treating lower back pain involve:
• Taking the load off the pain sensitive tissues and structures by getting into the most pain free positions as possible;
• Reducing inflammation with cold packs or medication;
• Protecting against re-injury with the use of tape or bracing;
• Promoting healing by reducing tissue tension with “hands on” techniques along with easy pain free, mobility exercises and heat treatment;
• Targeted stretching and strengthening exercises to correct muscle imbalances and joint alignment;
• Correction of posture, functional movement patterns (habits) and sporting techniques to prevent irritation of body structures and tissues;
• Core stabilisation exercises to build a strong, stable platform upon which whole body strengthening can be built;
• Functional strengthening to build your body’s capacity to cope with daily physical demands.

It is important that you understand that healing any tissue takes about 6 weeks and involves and a well-recognised progression through phases of healing. For example, the Bleeding Phase can last from 6-24 hours, Inflammatory Phase 2-5 days, Proliferation / Regrowth (framework) Phase 5 to 14 days, the Remodelling Phase 2 to 6 weeks and the Maturation Phase from 6 weeks to up to 12 months and beyond.

It therefore makes sense that if each of these phases are optimised, physically, nutritionally and psychologically and the actual causes of your back pain are corrected, then healing should not just be possible, but inevitable.

It is often quoted that it takes about 4 weeks to strengthen your muscles and at least 4 weeks to correct your posture or movement habit. So whilst not a quick fix, understanding that if you follow an evidenced based rehabilitation system that has been proven deliver results over time, you too can also achieve sustained improvement, through a progressive rehabilitation and conditioning program that will prevent re-injury and optimise your physical capacity.

If you are interested in learning about a 7 step plan that thousands of people have experienced relief through, call 1 300 BODYWISE (263 994) for a FREE Assessment and Recovery Action Plan. This plan will detail the specific steps that you need to take to on your road to recovery. Wishing you the best of health.

Yours sincerely,

Michael Hall
Physiotherapist
Director Bodywise Health

P.S. If you are in pain and you want relief, don’t put off getting effective treatment any longer.
Call 1300 BODYWISE (263 994) for a FREE, No Obligation back assessment and advice. You have absolutely nothing to lose except your pain and a healthier, happier life to gain.

References
1. Dreyfuss P. Hallbrook B, Pauza K et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygoapophysial joint pain. Spine (Phila Pa 1976)2000 25(10):1270-7.
2. Van Kleef M, Barendse GA, Kessels A et al. Randomised trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999:24(18):1937-42.
3. Yin W, Willard F, Carreiro J et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28(20):2419-25.
4. Pauza KJ, Howell S, Dreyfuss P et al. A randomised placebo controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine j 2004:4(1):27-35.
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