Patella femoral syndrome or maltracking of the knee is the most common presentation of knee pain where the outside structures of the knee are stronger than the inside structures of the knee. This causes maltracking and the knee cap to not sit correctly on the cartilaginous groove which causes inflammation and pain.
Often these people will get worse when sitting for long periods like on a long drive, a long haul flight, on a bike with the knee too low or when watching a long movie. This is because the knee is in a closed packed position where the knee cap or patella is closely packed into the groove on the femur which causes more inflammation and pain. This is rather than when you are upright where there is not as much pressure on the groove.
The first step is to consult your Physio Pro to discuss the causative factors for maltracking and patella femoral malalignment and the second step is to avoid the closed packed position in the short term until your biomechanics have improved.
This includes not doing hill or step running for fitness, lifting the bike seat up, frequent breaks with long sitting and bending and extending the knee when you have to sit for long periods.
When someone has had a serious or long term or difficult to clearly categorise injury, where there has been Doctors, Physios, scans and second opinions from everyone from their brother in law to the specialist then they may suffer from this condition. They are tired of having to get to another appointment. Tired of contradictory statements. Tired of not getting a clear result.
This is when there needs to be good communication between the allied health professionals and the Doctors or the specialists where there is shared opinion. Even if there is disagreement in the exact pathway of treatment patients in this day and age are educated and would benefit from sound argument and logic especially when it comes to their injury. This can be done with letters or emails or even better yet on the phone or in person.
Medical fatigue can also be improved by everyone involved taking the time to explain the presentation and their role clearly to the patient. Communication may also involve the young patients parents, the elderly patients children or the patients partner to make it clearer for all to understand the problem and the pathway ahead.
If you are confused about your presentation ask more questions. If you still feel that it has not been explained well you may wish to get a second opinion from another therapist or doctor as understanding your condition is the first step to recovery.
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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.
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.
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.
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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.
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.
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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.
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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.
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.
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