Specialist News

Core Stability Exercise vs General Exercise for Chronic Low Back Pain

LBP is one of the most frequently reported disabilities (60% – 80% of adults).40% of patients with LBP will not recover within 3 months.

Recent Research:

  • Shows core exercises provide a better outcome during the first 3 months of intervention compared to general exercise alone for people with LBP.1
  • Patients with LBP display a decreased activation  in transverse abdominus and multifidus.  Thus core exercises consist of regaining the strength of these muscles through motor control training.1
  • Patients are more likely to perceive the effectiveness of core exercises than that of other pain reduction methods.2
  • In the absence of high-quality evidence, clinicians must rely on their own clinical expertise and the values of their patients in deciding on core exercises in LBP treatment.1

Physiotherapy

SPS LBP physiotherapists have the clinical expertise to ensure the best results for your patients.

Reference:

1. Brian JC, Kenneth EG, Elizabeth RN, Lindsey EE. Core stability exercise Versus General exercise for Chronic lower back pain. Journal of athletic training 2017 Vol 52 (1) 71-72.

2. Chang WD, Lin HY, Lai, PT.  Core strength training for patients with chronic low back pain. J Phys Ther Sci. 2015;27(3):619-622.

 

Introducing the Sydney Physio Solutions Tendon Clinic

What

This is the latest development at Sydney Physiotherapy Solutions for the most up to date and effective treatment for:

• Tennis Elbow

• Achilles Tendinopathy

• Patella Tendinopathy

• Shoulder Tendinopathy

Who

The programme is led by Senior Physiotherapist, Wes Matthews who has studied under the leaders in tendon rehabilitation, Jill Cook and Craig Purdham. All SPS physiotherapists will follow the same proven treatment plan when dealing with tendon injuries.

Wes has prepared a protocol which has measurable outcomes, and these will be communicated with you and your patient throughout the treatment.

This protocol will be effective for everyone from the general population through to elite athletes.

Why

Our clinics offer dedicated physiotherapists who will deliver a structured assessment and treatment protocol. This will engage your patient in a clinical process of diagnosis and treatment designed for the very best results.

 

Conservative Physiotherapy Management and Shoulder Impingement Syndrome.

Shoulder dysfunction has a consistently detrimental effect on quality of life and is one of the most common presentations to physiotherapy. Shoulder pathology has a high morbidity rate, it is thus important to begin treatment early. In a systematic review by Kroner et al, the effectiveness of physiotherapy management was assessed.

Findings:

There is evidence that surgery is not more effective than physiotherapist-led exercises in the treatment of pain and disability in patients with shoulder impingement at follow up. There is evidence that manual therapy plus a shoulder exercise programme is superior in pain improvement compared with exercises alone.

Conclusions:

Patients should engage in a 3 month course of physiotherapy before being considered for shoulder surgery.

Clinical Significance:

It is generally preferable to manage conservatively a painful shoulder with an impingement dysfunction. Surgery is generally considered a last resort as it is often associated with a long period of post-operative rehab, and may not produce better results than conservative management. Physiotherapists at Sydney Physio Solutions, will optimise your patient outcomes with an evidence based approach to treatment incorporating education, scapulohumeral and rotator cuff exercises, and manual therapy.

Reference:

Kroner TO. et al. CHG. (2009) Effects of physiotherapy in patients with shoulder impingement syndrome: A systematic review of the literature. J Rehabil Med 41: 870–880

 

New Cochrane Review Shows Physiotherapy-Based Core Stability Exercises are an Effective Way of Improving Low Back Pain.

Background

Low back pain is a major health and socioeconomic problem associated with work absenteeism, disability and high costs for patients and society. Physiotherapy empowers the patients to take an active role in the prevention and management of low back pain by providing a tailored daily exercise programme.

Core stability exercises are one aspect of a programme aimed at restoring coordinated and efficient use of the muscles that control and support the spine combined with returning to functional activities. Core stability exercises should also be progressed to more complex tasks integrating the activation of the deep and global trunk muscles.

Evidence

In a recent systematic review, Cochrane group examined the use of core stability exercises for the management of low back pain. The core stability exercise programme ranged from 20 days to 12 weeks and included middle aged participants referred from their primary healthcare provider.

Core stability exercise demonstrated superior improvements in pain and function over simple analgesia and advice, and better than standard exercise alone. Some studies suggest that outcomes are better when used in conjunction with manual therapy. Hands on physiotherapy combined with core stability exercise has also been shown to have good outcomes

Recommendations

Patients require a comprehensive self management programme that includes both analgesia combined with a structured physiotherapy exercise programme. At Sydney Physiotherapy Solutions we provide a comprehensive core stability exercise regime to reduce pain and long term disability.

SaragioEo, BT., et al. (2016) Motor control exercise for chronic non-specific low-back pain. Cochrane Database of systematic reviews. Issue 1.

ACL Rehabilitation for Patients

About your operation
The anterior cruciate ligament is one of the major stabilising ligaments in the knee. It is a strong rope-like structure located in the centre of the knee running from the thigh bone to the shin. When this ligament tears unfortunately it doesn’t heal and often leads to a feeling of instability. During your operation, the ruptured ligament is removed and the graft which replaces your old ACL is taken either from the hamstring tendon or the patella tendon.

About this document
This document is designed to help you work through your rehabilitation programme. It outlines specific goals that you should be achieving within specific time frames and provides exercises to help you achieve these goals. Physiotherapy exercises should be started immediately after your operation and should initially be supervised by your physiotherapist. Start by performing 3 sets of 10 repetitions of each exercise.

Outcome Measures
Outcome measures should be completed at regular intervals through your rehabilitation programme. These objectively demonstrate how well you are progressing with your rehabilitation and when you are ready to return to competitive sport. Your physiotherapist will record these for you and report these back to your Doctor.

First

0-2 weeks – Acute stage:
By the end of this stage you should have increased your knee joint range of motion, have minimal swelling and begin to walk unaided.

Score1

Exercises
• Lying straighten knee
• Lying bend knee
• Straight leg- squeeze quads
• Hamstring stretch
• Calf stretches

2-6 weeks – control stage:
By the end of this stage you should have progressed to closed chain exercises, be performing basic balance exercises and have improved your knee muscle control.

Control-Stage

Exercises

• Controlled single leg lunge
• Squat to 90˚
• Single leg dip to 60˚
• Single leg balance on wobble board
• Calf raises

6-12 weeks – STRENGTHENING stage:
The aim is to improve your leg strength, particularly hamstring strength and begin hopping exercises. Jogging may begin at the end of this stage as long as there is no swelling and both a lunge and a hop are pain free.

Hamstring

Exercises
• High bridge-progress to single leg
• Straight leg deadlift +/- weight
• Squats with weight
• Single leg dip with weight
• Hopping forwards
• Squat jumping
• Box jumping

3 – 6 MONTHS – SPORT SPECIFIC:
By the end of this stage you should have progressed to non-contact sport specific drills, cutting movements and changing direction. Start mentally preparing yourself for sport.

Goals

Exercises
• Box jumping, varying heights
• Single leg hopping- sideways, backwards
• Cutting movements, changing direction
• Con’t with wobble board drills
• Sport specific drills
• Fast jogging, sprinting

 

6 MONTHS+ – RETURN TO SPORT:
Before returning to competitive sport you should have completed 1 month of full training and be physically and mentally ready for body contact sports. You should also feel confident with high intensity change of direction activities.
Exercises
• High level proprioceptive exercises
• High level plyometrics
• Sprinting
• Pivoting exercises
• Shuttle runs

OUTCOME MEASURES
Before returning to sport you should complete your final outcome measures. Yours single triple and cross over hop test scores should be above 90% of your non-operated leg. You should also complete a KOOS and ACL-RSI score so your therapist can determine how ready you are to return to competitive sport.