By Sophie Marshall

The temporomandibular joints (your jaw) are some of the most used joints in your body, as they are involved in eating, breathing, talking and facial expressions.

TMD can have many causes. Some common triggers include teeth clenching and grinding (which can be brought on by stress), injuries to the area, arthritic conditions, dental work or surgery that alters your bite, or anatomical deformities of your teeth or jaw.

Common symptoms of TMD include:

  • Jaw pain or discomfort
  • Clicking or locking of the joint
  • Headaches
  • Reduced jaw range of movement
  • Neck or facial pain
  • Earache or tinnitus

Conservative, non-invasive treatment such as physiotherapy is recommended in the management of TMD. Physiotherapy can reduce pain and improve function. In some cases, patients require other treatment such as intraoral appliances (mouthguards or splints), medication, injections, and occasionally surgery.

Physiotherapy treatment for TMD may include joint mobilisations, massage, acupuncture or dry needling, and the prescription of home exercises and self-management strategies.

Did you know? Your teeth should only touch as you swallow!

“Bad habits” to avoid that may be contributing to your symptoms of TMD:

  • Clenching or grinding your teeth
  • Chewing gum
  • Taking large bites of food
  • Chewing only on one side of your mouth
  • Biting your nails, pens etc.
  • Resting your chin on your hand
  • Chin sitting (resting your chin on your hand)

By Kim O’Leary

Do you ever wonder what the term ‘shin splints’ means?

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 this injury, and separates it from injuries such as stress fractures or compartment syndrome.

Major causes of MTSS are:

  • Flat feet
  • Calf tightness
  • Old shoes or shoes that offer poor support
  • A rapid increase in training workload; either in speed or distance

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 the surrounding soft tissue.

Despite being the most common lower leg complaint, MTSS is often a common misdiagnosis for similar conditions such as stress fractures or compartment syndrome.

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

Common signs of MTSS:

  • Aching along the front of the shin with physical 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
  • Pain that develops gradually over weeks/months
  • Swelling in the lower leg
  • Small bumps along either side of the shin bone

How to manage shin splits:

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, and thereby relieve symptoms.

After this initial period, more intense physiotherapy can be commenced. This usually involves deep tissue massage, Myofascial releases, muscle frictions, structure rehab programs to increase flexibility, strength and endurance, as well as gradual recommencement of 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. activities such as swimming, orbital training, beach walking/running).

In conclusion:

MTSS can be painful but it 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 (ie. ‘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!

By Sophie Marshall

Still working from the dining room table, or are you heading back into the office? How’s your posture after an hour or two?

Bad ergonomics are a pain in the neck/back/bum, so there’s no better time to optimise your workstation ergonomics!

Ergonomics help facilitate better posture. Good ergonomics reduce the kinds of postural stress and fatigue that can often cause neck and back pain, neurogenic (nerve) symptoms, and headaches.

Setup tips for your workstation include:

  • Using an adjustable chair with lumbar support or a lumbar roll
  • Ensuring that your feet are either flat on floor or you are using a foot rest
  • Ensuring that your hips, knees and elbows are at 90 degrees (or in a slight downward slope)
  • Ensuring that your keyboard and mouse are directly in front of you and within easy reach when your arms are resting by your side
  • Ensuring that your keyboard is flat or provides wrist support
  • Ensuring that the computer screen is no further than an arms reach away
  • Ensuring that the top of the computer screen is approximately at eye level
  • Ensuring that documents are directly in front of you and between keyboard and screen, or are in an appropriate holder
  • Ensuring that you do not hold your phone between your head and shoulder

Australian guidelines state that we should minimise the amount of time spent in prolonged sitting positions, and therefore break up long periods of sitting as often as possible. Sedentary behaviour is associated with poorer health outcomes, including an increased risk of type 2 diabetes.

A suggested work pattern is 20 minutes of sitting in a neutral posture, 8 minutes of standing in a neutral posture, and 2 minutes of moving and/or stretching.

Tips to help get you moving:

  • Have reminders/cues to move every 20 minutes
  • Take phone calls while standing
  • Drink plenty of water (toilet breaks and refills!)
  • Eat lunch and morning tea away from your workstation
  • Walk to a colleague’s workstation rather than using email
  • Move the bin and printer away from workstation
  • Make meetings standing or walking ones
  • Consider walking or cycling to work, or parking further away

Having an ergonomic workspace is only half the story; we need sufficient endurance of postural muscles, and extensibility of pectoral muscles to be able to maintain upright posture and scapular retraction.

Your PhysioPro can prescribe stretches and strengthening exercises appropriate for you at your next appointment!

For more information, please contact your local PhysioPro.

By Jack Gangemi

Falls place a large amount of pressure on the healthcare system and cause great personal angst in the community. Unfortunately for people over 65, falls are the leading cause of injury-related hospitalisations and the second most common cause of community injury hospitalisation.

Globally, approximately 28 to 35 per cent of people aged 65 and over fall each year. Thankfully, there is a large amount evidence showing that a targeted Physiotherapy balance exercise regime can greatly reduce the risk of falling.

The main risk factors for falls include:

  • Decreased lower limb strength
  • Poor ankle, hip and step reactions
  • Issues with glasses/eyesight
  • Urinary incontinence
  • Footwear
  • Home hazards
  • Medications
  • Dizziness/nausea

Strategies for reducing your falls risk include:

  • Physiotherapy balance and strength training
  • A medical review from a GP or Pharmacist
  • An optical check up
  • A footwear review with a Podiatrist
  • Reducing tripping hazards ie. rails in bathroom and shower

At PhysioPro, we can use standardized measures to assess balance reactions and a patient’s falls risk. From there, we can implement a tailored balance and lower limb strengthening program.

Physiotherapy for falls are aimed at 4 key areas:

  1. Gait retraining and advisement on appropriate walking aids – It is important that the patient is as independent as they can safely be. However, it is also vital that a fear of falling does not limit exercise!
  2. Balance – Targeted exercises for ankle, hip, and step reactions. We can challenge our patient’s balance reactions by manipulating their base of support (ie. standing with feet together, tandem stance, eyes closed, heel/toe walking, using Bosu balls, exercise balls, external perturbation practice etc.)
  3. Strength – Specific exercises to strengthen calf, quad, and gluteal muscles (ie. sit-to-stands, squats, bridges, lunges, calf raises etc.)
  4. Co-ordination – Putting it all together in functional movement

Contact your local PhysioPro to organise your own fall prevention program!

By Allister Horncastle

A question I am frequently asked is: “I have a sore calf, have I strained it?”

The best way to answer this is to ask yourself:

1. Was there was an event that caused immediate calf pain?

2. Or did it build up slowly?

The answers to these questions will almost always dictate whether you have an acute calf injury or something else.

I have recently seen an increase in patients presenting for an assessment of calf pain.

The majority are returning to regular exercise – and particularly running type activities – after a layoff. The two most common presentations are:

1. Acute onset pain when jogging/running, or explosive type movements.

2. General soreness that appears during or after activity.

The main reasons for both presentations are generally unaccustomed loading and weakness.

Here are some self-management strategies for both pain types:

Acute pain:

  • Follow POLICE rules (Protection/Optimal Loading/Ice/Compression/Elevation).
  • Avoid HARM (Heat/Alcohol/Running/Massage).
  • Avoid Anti-inflammatory drugs (Nurofen/Voltaren).
  • Listen to your body: if you are limping, your body is being protective of the painful area. Know that limping is ok for a short period of time.
  • Finally, get an appointment with your physio to guide management.

Slow onset pain:

  • A rest period of 24 hours between aggravating activity may help.
  • Use heat through the muscle.
  • Massage and stretching may help.
  • If it is ongoing for longer than 24 hours, it is probably not just muscle ‘soreness’ and therefore, it needs to be assessed by a physio.

This is not by any means an exhaustive list of calf pain causes, but is a quick and simple guide to help you decide what needs to be done. 

If you have calf pain and are unsure about management, contact your local Physio Pro clinic for an appointment.

June 15-22 is Men’s Health Week, so it’s time to talk about prostate health!

What is the prostate?

The prostate is a walnut sized gland that sits below the bladder and produces majority of the fluid that makes up semen. It is normal for the prostate to grow as men age; however, as the prostate surrounds the urethra, this can cause difficulty urinating.

In Australia, prostate cancer is the most common cancer among men. It occurs when abnormal cells develop in the prostate and continue to multiply in an uncontrolled manner. Generally prostate cancer is slow growing, however high-grade disease can spread quickly.

Should you be getting checked?

Men over 50 years of age, or over 40 with a family history of prostate cancer, should talk to their doctor about screening for prostate cancer as a routine part of their annual check-up.

What symptoms should you ask your doctor about?

  • Frequent or sudden urge to urinate
  • Difficulty urinating eg. slow to start or weak flow
  • Discomfort when urinating
  • Blood in urine or semen

What about physiotherapy?

If you have pain in your lower back, thighs, or hips, talk to your PhysioPro. They are experts in diagnosis and treatment of musculoskeletal complaints. Your PhysioPro will refer you for further investigation if required.

Some men will undergo a procedure called a radical prostatectomy to remove their prostate. Up to 95% of men experience urinary leakage (incontinence) as a side effect of the surgery.

There is evidence that practicing an individualised pelvic floor exercise program both before and after surgery can help men to get drier, faster.

PhysioPro’s Sophie has completed post-graduate studies in continence and men’s health. She helps prepare patients for their prostatectomy surgery through education, use of real-time ultrasound (a non-invasive assessment technique), and prescription of pelvic floor exercises.

For more information on men’s health physiotherapy, please contact your local PhysioPro.

To all our breastfeeding mums: did you know our women’s health PhysioPro Sophie treats blocked ducts and mastitis?

Sometimes the ducts that carry the milk from deep in the breast to the nipple can become blocked. Milk builds up behind the blockage, resulting in a painful lump.

If the blocked duct is not cleared quickly, milk can be forced into nearby breast tissue, resulting in tissue inflammation called mastitis, and sometimes infection.

Some tips to manage blocked ducts at home are:

  • Apply a warm compress to the area before feeds
  • Get into a comfortable relaxing position before breastfeeding
  • Breastfeed regularly and from the affected side first
  • Ensure baby is well attached, and vary the feeding position
  • Gently massage the lump towards the nipple during feeds
  • Ensure breasts are fully empty: express if needed afterwards
  • Apply cool packs to relieve pain and inflammation

Find more information here.

If you are unable to clear the lump within a couple of days, it is time to consult your PhysioPro for further advice and treatments including ultrasound therapy.

If you are feverish or feeling unwell, consult your GP as you may require antibiotic treatment.

By Allister Horncastle

As we all keep to the government’s regulations – which thankfully are continuing to ease – in the clinic I am noticing an influx of people with non-specific knee pain. It’s often from an increase in running or from commencing a running program. However, it’s not just runners that are getting this pain: it’s also experienced by gym junkies, gardeners, walkers and non-fitness folks alike.

With this type of knee pain, you often don’t remember a specific event that injured your knee. Instead, you notice that your knee starts to hurt during, after or the day after physical activity.

What you’re experiencing is likely Patellofemoral Joint Pain (PFJP), commonly known as ‘Runner’s Knee.’

It’s likely you’ll have pain at the front of the knee towards the middle, but pain can also present on the outside, at the back or any combination of the above. It may warm up as you exercise, worsen so you have to stop or you may only notice it post activity.

A recent patient of mine started running after a long layoff and pulled up sore.

This continued for 2 weeks until she attended the clinic. Her pain was under the kneecap and towards the middle, and it would be sore while she running, with the pain continuing until the following morning. Interestingly, she had the same pain when she was sitting at her desk with her knee bent for prolonged periods at work, even when she had rested the day prior. This is another common characteristic of Runner’s Knee. It might sound familiar to some of you?

What’s occurring in this scenario is an abnormal biomechanical load through the patellofemoral joint (the joint between the kneecap and thigh bone). Unlike the majority of joints in the lower limb, the patellofemoral joint isn’t rigidly held in position by strong and taught ligaments, so it is more vulnerable to a number of internal and external factors. 

Internal factors include:

  • Tight and/or weak muscles around the hip and the rest of the leg
  • Stiff joints
  • Flat feet
  • Inflammation
  • Previous injury
  • Poorly aligned bony architecture

External factors include:

  • Inappropriate footwear
  • Altered training surfaces
  • Altered training loads
  • Ergonomics
  • Diet
  • Age

A physiotherapy program can be tailored to target an individual’s internal and external factors, and in the vast majority of cases, you will return to your chosen activity. In other more severe cases, external referral may be required and this can be provided by your physiotherapist. In either case, if your knee pain sounds anything like this, physiotherapy should be your first point of call.

For my patient, her knee pain was caused by a combination of both internal and external factors. We were able to:

  • Alter her running program to allow sufficient rest between runs
  • Get her in more appropriate shoes for her foot type
  • Loosen tight muscles
  • Reduce inflammation
  • Strengthen the muscles around the hip to allow normal biomechanics of the lower limb

This process took multiple sessions over only a few weeks and she is now running pain free and would have been able to run the HBF Run-For-A-Reason in May.

For more assistance, please contact your local Physio Pro.

Exercise Spotlight ‘THE BRIDGE’ with PhysioPro Justin Rudolph.

The bridge is a great gluteal strengthening exercise but also target other muscles such as the rectus abdominis, erector spinae, hamstrings and adductors.

Justin demonstrates a standard bridge and then progresses it to lower base of support with arms crossed, single leg lifts which challenges him further and recruits the quadriceps and hip flexors.

This is a great exercise for early stage knee and hip surgery and great for gluteal engagement.

By Kim O’Leary

From an evolutionary perspective, we are designed to be standing upright, looking over the savanna for our prey or predators. Before this, as primates, we were designed to be in the jungle swinging between trees with traction forces elongating the spine and decompressing our discs. 

Enter today, we spend our time flexed and hunched over our iPad, iphone and laptop, flexing our spines and compressing our discs. This exhibits forces to the intervertebral discs’ extruding the contents backwards and over a prolonged period can cause compression to our nerves. This may lead to muscle spasm, pain and tension.  

Then enter the iPhone, which was released in 2004. We don’t have long term data on the accumulative effects of this but the change in our generational posture cannot be understated.

We are the first generation who will be faced with the consequences of being flexed for such long periods of time.

At best, it could cause muscle spasm and some postural pain. At worse, over a long period of time, it may triangulate our intervertebral discs. Possibly, even the bone matrix of our vertebrae could also be compressed at the front / anterior aspect and over a long period of time this could cause kyphosis or hunched postures of a generation of people in their middle ages’.

Flexing forward for a long period of time doesn’t only affect our spine, but all the surrounding musculature will also be affected. The ligaments are in a sustained stretch position which causes the nerve endings to begin to complain to us. The muscles around our spine are designed to be slow twitch fibres which allows great endurance. However, our maker never envisioned that we would sit hunched for 10 hours plus per day. This causes trigger points in the muscles, better known to the layperson as a knot. This can itself be painful and impinge the nerves that run through the soft tissue. 

Muscle imbalances can also occur. Our back muscles spend their day on a long stretch and the muscles at the front are constantly activated causing pain and soreness. 

We could all take up Pilates. Its forefather, Joseph Pilates, has his background in ballet dancing and ballet dancers have the most fantastic postures; ideally curved spines and amazing musculature. But can we realistically practice ballet three times a week and expect the muscle balances to equal out?

Perhaps we could all take up Irish folk dancing. They can stand bolt upright and flick their heels to their backsides with amazing ease.

‘Back in my day’, I heard our parents generation say we used to put books on our heads and balance them with our strength and postural muscles. Maybe this is the answer, maybe we should ask the current generation (Millennials) to put books on their head whilst they are texting and keep them there to ensure their posture is right.

I’m not sure that any of these will be the answer for an epidemic of text neck. What I would put forward is a series of exercises that you could complete once daily for 2 stickers from the teacher, once every other day for one sticker or once a week at the very least to keep you out of detention. 

  1. Firstly, you need a stable base for the neck to work from. This is where you would do; Pull backs/Pull Downs/ Prone flys and T’s, Y’s and L’s on the fitball to engage all the back muscles. Ask your PhysioPro to demonstrate.
  2. Secondly, you need to counteract the chin poke forward posture. Look at the people that need the strongest necks. Namely people under G forces – fighter pilots and F1 racers. The exercises that they do to protect themselves from their work postural stress could work for all of us. Theraband Cervical retraction is a great example.
  3. We then need to counteract the neck looking down posture with the opposite; Extension of the neck. Look up sustained for 5 seconds every few hours to relieve the accumulation of flexion stress.
  4. Trigger point development is another problem. Foam rolling and spikey ball relief will certainly help this.
  5. Stretches of the pectorals will help with muscle imbalances that occur from spending our life in a prolonged flexed posture.

I think if you follow these principals then you can expect to keep your neck happy, your spine ‘straight’ and your text neck at bay.