Yoga and Physio

Yoga is now widely recommended by physiotherapists to help with injury prevention and recovery. The way in which it can help is by the slow and controlled movements can help with better biomechanics.

For example with a person with a chronic back injury the slow and controlled movements can help engage abdominal muscles first to stabilise the trunk and then use the distal limb to move optimally. Or the patient with recurrent hamstring tears he can wake up the gluteal firing which can off load the hamstring reducing fatigue and improving performance through this improved motor sequencing.

There are other yoga styles which is meditation based which can also be used for mental purposes like relaxation, stress management and spirituality.

So yoga can have a lot of benefits for the regular community athlete and will be beneficial for physio’s to incorporate in their management of their patients.

Exercise Physiologists and Physiotherapists

The relationship with physiotherapists and exercise physiologists (EP’s) is a great one to develop and create through open communication with each other. In the private practice setting there are alot of opportunities to meet EP’s and start the communication.

On a broad level physic’s skill sets are in anatomy, biomechanics and physiology and how that relates to injury in the acute and subacute overuse sense. We are set up with space to assess and diagnose and manage in the manual therapy however not the room to develop large scale gym movements so we are limited with how far we can progress the rehabilitation phase.

EP’s skill sets in exercise selection, progressions, regressions and safety of exercising in the gym environment. The environment they work in is usually more conducive to long term injury prevention and rehabilitation. Machines and the exercise rehab environment is constantly changing so it is imperative that this knowledge base is kept up to date.

Therefore a relationship of cross referrals with these two allied health professionals can be a great symbiotic one to ultimately give the patient better outcomes for their injury and problems.

As physios we can’t be everything to everyone but we can be the right person to direct them to like minded colleagues with a different skill set to compliment ours.

Physios Running Away with the Circus

Have you ever watched a circus entertainer and remark on their anatomy, flexibility and strength. With these athletes brings an unusual role of a sports physio to keep these athletes who may be super strong, hyper mobile or super athletic at their best and keep them injury free.

Like with a lot of things prevention is better then cure. Screening plays a big role with this line of work to develop programs where athletes can be cleared of injury but also have risk factors identified.

Circus injuries can be twisting turning injuries which can rupture ligaments or cause fractures with a mis timed leap or jump but commonly there are a huge amount of over use injuries die to the extreme and intense nature of the training.

A lot of circus performers are gymnasts and a lot have problems associated with that intense training like pars defects of the spine which require specific management and knowledge.

These jobs aren’t what you expect when you graduate from the school of physiotherapy but they sure are a varied and interesting part of the physiotherapy profession.

Doping and Physio

Doping and illegal drug activity has been prevalent in all sports but never has it been highlighted more than with the Essendon supplement scandal which threw the team into chaos and eventually lead to multiple suspensions, loss of a Brownlow Medal and loss of respect from the national sporting world.

Physiotherapists have obligations when they are involved in sporting teams. It goes without saying that they should  not possess any substances, tamper with any doping control and co-operate fully with the authority involved.

But a good physiotherapist who is in the sporting field will be knowledgable of the WADA rules and regulations as even if the athlete was unaware of what was being administered they will ultimately be held responsible for a positive test. In some cases there can be contamination of nutritional supplements which can also result in an unintentional positive test.

The role of the physiotherapist is wide and varied but to be great at your job even in an area somewhat outside our scope you need to know a little about a lot of things so you can be of most value in the sporting environment.

Waterworks is also Men’s Business

Wetting your pants is often joked about as problem we develop in old age. It is also more commonly associated with women however there are a lot of men who will suffer the same problem.

Consumption of caffeine and alcohol can affect our waterworks so sometimes if there is a problem it may simply be a case of having more water and less coffee and beer. But the urge to go more often then others can also be habitual. For example if we ‘just in case toilet.’ We go to the toilet before we go out, when we walk past a toilet, before we hop in the car ‘just in case,’ which creates the feeling of fullness earlier.

Men can specifically have problems with toiling if they have an enlarged prostate, after prostate surgery or even if they have chronic constipation it can stretch the muscles and damage the nerves similarly to childbirth with women.

It is important to consult your Physiopro with some ideas about how to strengthen your pelvic floor if you are having problems with your waterworks.

Physio Going to the Dogs

Physio is not just for humans. Animals can also have their favourite physio treat them as well. Horses and dogs are the primary animals that have physio because their performance can be monetised but their is also physio that can be used for animals that

Just like humans animals have operations, they need splints, they can tear ligaments and develop problems with their brain which will affect the functioning of their body. Also just like humans they can benefit from stretching, massage, joint mobilisations and trigger point soft tissue work.

Animal physios need to know a whole different set of anatomy so they usually specialise in a particular animal. Communication for an animal is also somewhat difficult so it does require a special skill set to work out where the injury is and what can be done for them.

Contact the Australian Physiotherapy Association to find a member of the Animal Physiotherapy Group if your dog needs treatment.

Astronauts and Dizziness

Did you know that when astronauts return to earth they suffer severe vertigo symptoms as their inner ear which is the major part of our vestibular system has to adjust to effects of gravity back here on earth. They can suffer nausea, vomiting and loose their balance.

This problems is not just isolated to going into outer space. Vertigo in the general population is also very common and can be one of the most common things that a physiotherapist will get a referral from a GP for.

Physiotherapists are trained with strategies to desensitise the vestibular system with methods such as the Employ’s and Dix-Hallpike procedure.

Call your Physiopro today to discuss how they can help ease and settle your symptoms of dizziness.

Pain in the Leg

Do you ever wonder what the term shin splints means? The term shin splints has been widely used as a catch-all term referring to a collection of different conditions that cause lower leg pain. The term Medial Tibial Stress Syndrome (MTSS) better defines the injury and separates it from injuries such as stress fractures or compartment syndrome. MTSS is caused by chronic strain, overuse, and microtrauma of the soleus (calf) muscle at its origin on the inside of the shinbone (posteromedial tibia), or deep inflammation of the periosteum, which is the connective tissue that covers the bone, of the tibia beneath the posterior tibialis muscle. MTSS usually occurs in unconditioned people who begin a new running or jumping activity or conditioned runners who change or increase their speed or distance or change their type of shoe or running terrain. MTSS also affects individuals who have flat feet because the mechanics of the foot increase stress on the soleus muscle.

MTSS is the most common presentation of lower leg pain, with pain localized to the inner portion of the tibia in the middle/lower thirds of the lower leg and in the surrounding soft tissue. With MTSS, pain usually disappears once the activity that causes the pain is reduced or stopped. An X-Ray sometimes shows chronic cases of MTSS, where there is a mild thickening of the tissue surrounding the tibia (periostium) or an uneven edge at the end of the tibia in the back. Despite being the most common of lower leg complaints, MTSS is often a common misdiagnosis for similar conditions such as stress fractures and compartment syndrome.

It is important not to forget that stress fractures can also give you pain in the leg. It often follows as a result of shin-splints that have not been managed correctly or when patient tries to “run-through” the problem which is why it is important to manage MTSS correctly.

Major causes are;
Flat feet
Calf tightness
Poor shoes or old shoes
Rapid increase in training workload; either speed or distance

Things to look out for;

Aching along the front of the shin with activity. The pain may begin as a dull aching sensation after running. The aching may become more intense, even during walking, if ignored.
Pain along the inside (medial) part of the lower leg

Generally, develops gradually over weeks/months

May have swelling in lower leg

Tender areas are often felt as one or more small bumps along either side of the shin bone.

Things to do to manage it;

Initially you can manage it with rest, ice and anti-inflammatories (ie nurofen, voltaren). Physiotherapy at this stage will involve ultrasound, light massage, and education with guidelines into exercise intensity and frequency. This aims to settle and relieve the inflammatory process thereby relieving symptoms. More intense physiotherapy can then be commenced. It usually involves, deep tissue massage, Myofascial releases, muscle frictions, structure rehab programs to increase flexibility, strength and endurance and gradual recommencement to normal activities. Throughout rehabilitation your physiotherapist will advise you on continuing aerobic fitness activity, however it will likely be modified to reduce lower limb impact (ie swimming, orbital training, beach walking/running)

Conclusion; MTSS can be painful but is usually easily resolved. If you experience pain in your shin, thoroughly stretch before exercising, reduce your activity level, and check your footwear. If you run on a hard surface, find some softer ground to train on. Avoid training errors (‘start low and go slow’). Introduce gradual changes in intensity, activity, and terrain. Maintain adequate calf and anterior tibial flexibility, strength, and endurance.

Happy Running!

Rock and Ankle Roll

Rolled ankles are one of the most common injuries that Physio’s see in athletes. In facet it accounts for 10 to 30% of sports-related injuries in young athletes.

The term “sprain” merely indicates that a ligament has been damaged. Sprains are divided into several groups depending on the severity of damage to the involved ligament. Most ankle sprains happen when the foot turns inward as a person runs, turns, falls, or lands on the ankle after a jump. This common type of sprain is called an “inversion injury”.

Physios grade ankle injuries as grade one, two and three. Grade one is the most common and requires the least amount of treatment and recovery. The ligament are often over-stretched and damaged microscopically, but not actually torn. The ligament damage has occurred without any significant instability developing. Grade 2 sprains are more severe to one or more of the ligaments and indicates that the ligament/s have been more significantly damaged, but there is no significant instability. The ligaments are often partially torn with evident swelling and bruising. Grade 3 sprains are the most severe. This indicates that the ligament has been significantly damaged with rupture of two or more ligaments, and may involve a fracture. Instability results and pain will present on the opposite side of the sprain due to tissue compression.
Your PhysioPro will provide a specialised rehabilitation program dependant on your degree/grade of injury. Treatment will likely begin with education concerning rest, icing, compression and elevation of the sprained joint, taping, and the issuing of crutches (if required). Physiotherapy specific interventions may include mobilization/manipulation of the joint, ultrasound, contrast baths, electrotherapy and a thorough rehabilitation program consisting of balance and strengthening exercises, and ankle propriocpetion, with an aim of return to full activity.

As a general guideline recovery from first degree sprains can take up to 2-3 weeks, recovery from second degree sprains can take 3-6 weeks before return to full activity, and third degree sprains can take as long as 8-12 months for the ligaments to fully heal. Your PhysioPro will be able to best determine a likely timeframe for a return to activity by considering all of the above factors.

Even after a return to activity, some protection is most often needed for the ankle joint for at least six months, as remodeling of the ligament is not complete until then. This often comes in the form of taping, supports or braces and/or a change in footwear.

Call your PhysioPro for advice on that sprained ankle today!

Is That a Rock in My Shoe? Or is it Plantar Fasciitis?

Is that a rock in your shoe? Maybe not. It could be plantar fasciitis or heel spurs.

The plantar fascia is a thick, broad, inelastic band of fibrous tissue that courses along the bottom (plantar surface) of the foot. It is attached to the heel bone (calcaneus) and fans out to attach to the bottom of the metatarsal bones (long foot bones) in the region of the ball of the foot. Because the normal foot has an arch, this tight band of tissue (plantar fascia) is at the base of the arch. In this position, the plantar fascia acts like a bowstring to maintain the arch of the foot.
Plantar fasciitis is a self-limiting condition that is the most common cause of heel pain on the sole of the foot. It refers to an inflammation of the plantar fascia. The inflammation in the tissue is the result of some type of injury to the plantar fascia. Typically, plantar fasciitis results from repeated trauma to the tissue where it attaches to the calcaneus. This repeated trauma often results in microscopic tearing of the plantar fascia at or near the point of attachment of the tissue to the calcaneus. The result of the damage and inflammation is pain.

If there is significant injury to the plantar fascia, the inflammatory reaction of the heel bone may produce spike-like projections of new bone called heel spurs. The spurs are not the cause of the initial pain of plantar fasciitis, they are the result of the problem. Most heel spurs are painless. Occasionally, they are associated with pain and discomfort and require medical treatment or even surgical removal.
Pain on the bottom of the heel most prominent with the first steps taken in the morning is the most common presenting complaint of plantar fasciitis. Typical morning pain is caused by the foot resting in a pointed position (plantar flexion) during the night, allowing the fascia to contract. With the first steps of the day, the irritated fascia is stretched, resulting in pain. Pain also occurs with the onset of activity such as walking and running. It typically starts as a dull, intermittent pain in the heel and may progress to sharp, constant pain. This pain may decrease as activity progresses, but it usually returns after resting and then resuming activity. In severe cases, the pain may occur with any weight bearing. Although the pain usually occurs in the heel, it can radiate throughout the bottom of the foot toward the toes.
Plantar fasciitis is common in runners and dancers who use repetitive, maximal ankle and foot range of movement. It is also common in those who experience sudden weight gain and in overweight individuals who increase their activity level.

The condition is usually caused by a change or increase in activities, no arch support, lack of flexibility in the calf muscles, being overweight, a sudden injury, using shoes with little cushioning on hard surfaces, using shoes that do not easily bend under the ball of the foot, or spending too much time on the feet.

Factors that could be contributing are fallen arches or rolling in when running, age, poor shoes or support and a rapid increase in activity.

Consult your local PhysioPro to treat the problem. They will use ultrasound, deep tissue massage, prolonged stretching, and a specific exercise program to improve flexibility and elasticity of plantar fascia. Secondary to therapy, self-care is a vital component in the rehabilitation process. The use of non-steroidal anti-inflammatory medication (NSAIDS) e.g. voltaren, nurofen, aspirin, can help significantly to reduce the amount of irritation and inflammation in the plantar fascia. You will also get a home program which will include deep tissue massage, foot rolling with a golf ball or similar, stretching the calves and plantar fascia and avoidance of repeated impact and stress.

 

So get that rock out of your shoe and get into see the PhysioPro team today.