Physiotherapists

When to See a Physiotherapist

Feeling pain? Joints hurting? Have an injury? There are lots of different reasons why you should see a physiotherapist. Not only can they help you deal with pain, but also they can help improve your quality of life.

Physiotherapists are highly trained and have a very detailed understanding of the human body based on years of study at university level. At Sydney Physiotherapy Solutions our physiotherapists also continue their education by attending professional training regularly so that they are up-to-date with the latest treatments & scientific data.

It is not necessary for you to be injured before you seek help from a physiotherapist. All our physiotherapists are great at helping prevent injuries as well as treating them after they appear. We are here to help you achieve your health goals and there are lots of different methods of assessment prior to commencing exercise.

You should consult a physiotherapist if

  • you have sustained an injury
  • you have had recent surgery on a limb
  • you have low back pain, either acute or chronic
  • you have aches & pains in your muscles and joints
  • you have joint problems; hurting, locking or giving away
  • you would like to increase your balance, strength & flexibility
  • you experience numbness or pins & needles
  • you would like to improve your sporting performance.

At Sydney Physiotherapy Solutions we have a great team ready to help you. We are conveniently located – 2 clinics in Sydney CBD, one in Macquarie Street & one in Castlereagh Street and a clinic in Chatswood, very close to the transport Interchange. Phone us now or book online.

Stretching for Runners

From a young age many of us have been taught that stretching prior to exercise helps prevent injury. However, with the ongoing debate about whether to stretch statically or dynamically, and before or after running, many runners are not sure on how to choose the best stretching strategy for optimal results and reduced injury.

As physiotherapists we are regularly asked questions such as:

Is it better to stretch before or after running?

Does stretching help reduce injury or pain?

Can stretching improve running performance? and

What is the best type of stretching?

It is apparent that stretching still causes plenty of confusion.

Common types of stretching.

The most commonly performed techniques can be broken down into static and dynamic stretches. (though there are many different variations of these.)

Static stretches are the type many will be familiar with from childhood sports; passive positions held for a period of time, usually twenty to thirty seconds, aiming to gradually lengthen the muscles. Typical examples are the sit and reach type stretches, such as the hamstring stretch.

As a physiotherapist I find that because these stretches can be boring, people often tend to rush through them reducing any potential effectiveness.

Dynamic stretches are a bit more complicated, involving stretching the muscles and joints whilst moving. In dynamic stretching the limbs are purposefully moved into a lengthened position, preferably one that is activity or sports specific. Examples include slow jogging on the spot while bringing the knees up the chest or kicking the heels to the backside, or a slow walking lunge.

Which should I choose and what does the research say?

Up to date research suggests that the common practice of static stretching before an athletic performance such as running may not be that useful in reducing overall injury rates. A study appearing in the Scandinavian Journal of Medicine and Science in Sport  which analysed over 100 research papers published between 1966-2010 found that generally, static stretching before activity should be avoided as the only form of warm up. The researchers asserted that static stretching alone directly prior to exercise may have no additional benefit to injury prevention and may actually have a negative effect on maximal muscle strength and explosive performance.

Though other studies have found that static stretching may have a specific benefit to tendon and muscle injury only which may be of interest to runners, it is apparent that the best approach to take prior to running is an effective warm up session.

The warm up session should consist of a combination of low intensity aerobic activity for example a walk or very light jog (even on the spot) followed by dynamic (preferably activity specific) movements/stretching. The warm up is a crucial component of any exercise performance, especially prior to high demand activities such as sprinting and long distance running, and is important in preparing for optimal performance and reduced injury.

As the total investment of time should be similar regardless of whether a person chooses static or dynamic stretching, there are few excuses for missing a proper warm up.

Examples of dynamic stretches for running:

Some examples of dynamic stretching include walking lunges, walking bringing the knees up to chest or kicking heels to the backside and standing high kicks.

What you need to know:

• All dynamic movements should be performed slowly and with control through full available range of motion without jerky movements, over-stretching or pain.

• Each movement can be repeated a number of times for thirty seconds to one minute each as a rough guide.

• Individual programs will vary depending upon a persons requirements, as there are many more different options.

• Please see your physiotherapist of exercise physiologist to discuss your individual needs if you are unsure

Heels to backside

 

Knees to chest

 

Side to side lunges

 

High kicks

 

Walking lunges

 

 

Is there a place for static stretching anywhere?

It is generally accepted that improved flexibility can play a role in reducing injuries overall and for that reason static stretching can be used regularly as part of a healthy lifestyle or training plan at times other than directly before exercise. Read more.

It is encouraged to make an effort to stretch regularly as part of a healthy lifestyle to combat the physical demands of modern life and the negative stresses than we place on our bodies through, for example, long periods of sitting at work or using a computer. A stretching break can also provide a great escape from the hustle and bustle of life and to relax the mind, all potentially reducing the overall likelihood of injury when it comes time to perform.

This is general advice only so before getting started your physiotherapist can help you, whether you are a casual runner or an elite athlete to guide you specifically on what may be most suitable for your needs in formulating a stretching or exercise plan, or to help you address a specific complaint or injury.

Chronic Ankle Instability

Chronic ankle sprain and instability treatment

Chronic ankle sprain and instability treatment

What Causes Chronic Ankle Instability?

People who have a sprained their ankle may develop chronic (long-lasting) ankle instability. It is considered to be chronic if the ankle joint still gives way too easily six months after the first sprain, or if the ankle is sprained again within six months of the first sprain. One quarter of all sporting injuries are ankle related, and 85% of the time these are lateral ligament complex problems.

This kind of instability can develop if the ankle ligaments are overstretched or torn, and heal too loosely (mechanical instability). The interactions between the bones in the ankle and the surrounding ligaments and muscles may be disrupted too. The body has an unconscious awareness of movement and spatial orientation within the body, known as proprioception. This helps to coordinate the movements of the joints by using unconscious reflexes to stabilize them and keep the body balanced. So if an ankle feels permanently unstable, this might not only be caused by overstretched ligaments, but also by a problem with proprioception or resulting problems with muscle coordination.

Chronic Ankle Instability Treatment Options

There are a few different treatment options for chronic ankle instability. At first “functional treatment” is tried, involving physiotherapy to strengthen the joint, and possibly wearing an ankle brace or rigid tape to stabilize it.

One common approach is called neuromuscular training. The aim is to improve the stability, strength and coordination of the ankle. Studies show that neuromuscular training can speed up the healing process of ankle stability and mobility in the first few weeks. But there is not enough research to be able to say what effects this treatment has in the long term.

If the joint remains unstable despite training because the ligaments are too loose, surgery may be considered. One option is to shorten and tighten the ankle ligaments. This is not a very common approach and is usually utilized when all other avenues have been exhausted.

Chronic Ankle Instability Rehab

Chronic Ankle Instability Rehab

Chronic Ankle Instability Surgery Recovery & Rehab

Getting back to sport after surgery

Ankle instability often leads to problems with muscle coordination. For this reason, ankle exercises are a very important part of rehabilitation after surgery. Wearing an ankle brace during this time may also help. Braces not only support the joint from the outside – the pressure will also help you develop a good sense of muscle coordination again.

People probably benefit from starting movement, strength and coordination exercises two to three weeks after surgery at the latest. Studies suggest that people who do this become active again sooner than those who wear an ankle brace for six weeks and do not do any exercises during that time. In the studies, the participants who started doing exercises and strength training earlier were able to go back to work about one to two weeks sooner. They were also able to do sports again about three weeks earlier. But after about two years no advantages could be seen anymore: the stability and mobility of the affected ankle were the same in both groups.

Physiotherapy Vs surgery?

There were no studies comparing surgery directly with physiotherapy or other treatments. For this reason, it is not possible to say who might benefit most from surgery or how effective it is compared with non-surgical (conservative) treatment.

It is also not clear how the different surgical procedures compare with one another. There are only few small trials on this, and they do not provide reliable results. More research is needed to be able to answer this question.

Overall, it is currently not clear whether surgery leads to a faster recovery than strength and coordination training does. But if the ankle remains unstable because of loose ligaments, surgery might be an option. Whichever treatment you go for: with a little patience, sprained ankles usually become stable again.

If you are suffering from an ankle injury and are looking for a Sydney CBD physio contact the team at Sydney Physio Solutions who can help you get back on your feet again.

Superfoods – the Fermenting Frenzy!

Over the past decade the term ‘superfood’ has became a house-hold name and has seen many people fighting over the last bunch of kale in the supermarket! However, there is a new trend that has recently risen to the nutritional hall of fame: fermented foods.

I’m sure we all know a few friends that have traded in their morning coffee for a glass of kombucha, but is there any truth to the claims of endless health benefits associated with the ancient process of fermenting that has been practiced by humans for thousands of years? Can we supplement our physical health and performance by swapping our sweet potato for a side of kimchi? Let’s have a look at some of the facts:

What actually are ‘Superfoods’?

There is no official standard for what is classified as a ‘superfood’. It is commonly understood that any natural food containing a high-concentration of nutrients, such as antioxidants, qualifies for the title. A few of the favourites in this category include berries, acai, kale, chia seeds and coconut oil – extra virgin of course!

Despite the hype, it is important to take a holistic view of diet and exercise. Choosing your groceries based on high antioxidant content alone is not going to help you reach optimal health or that next fitness goal.

Why ferment your food?

The main reason that people ferment their food in the modern era is for the suggested health benefits that it provides. Fermentation is a metabolic process where organisms, such as bacteria or yeast, covert organic compounds such as sugars and starch into alcohol or acids.

For example: Lacto-fermentation uses bacteria to convert sugar and starch into lactic acid. This produces foods such as yogurt, fermented vegetables like saurkraut and kimchi, and cheese.

I have a ‘gut’ feeling about some of the benefits of fermented foods..

Fermented foods contain ‘good bacteria’ and microbes which can increase your gut health.

Other suggested benefits include:

  • Increasing the levels of micronutrients in foods
  • Aiding digestion. Fermented milk products for example can contain enzymes which help to break down lactose, potentially making it easier to digest for people who are lactose-intolerant.
  • Increased availability of minerals. Some natural foods such as legumes and seeds contain phytic acid, which binds zinc and iron together. This means our bodies aren’t able to utilise these minerals. The fermentation process breaks this acid down, allowing our body to use those minerals.
  • Changes taste: If you prefer a tangy or sour twist to your food, this could be for you. Similarly, the process produces carbon dioxide, giving the food a bubbly quality; like soft-drink but without the guilt.

Be sure to read the fine print

Lacto-fermented vegetables are one of the most common fermented foods in Australia. Be warned: these are not mass-produced. So if you are buying these products, such a sauerkraut, from the supermarket then chances are they have either been preserved using vinegar or the organisms are already dead. You would be much better served setting your kitchen bench up as a fermentation station, or visiting your local health-food store or delicatessen for these products.

If you do decide to ferment at home, hygiene during this process is very important as you are working with bacteria. So please take care to avoid contamination with microbes such as E. coli and botulnum, which have been linked to multiple illnesses.

Also be wary that some of these fermented products contain a high sodium content, particularly if lacto-fermentation has occurred.

The Verdict on Superfoods?

There certainly appears to be some health benefits associated with this latest craze, the most plausible being the live microbes that are added to the existing ones within our gut. This can aid in digestion and enhance our immune system functioning.

Some of the more far-fetched claims, such as reducing risk of cancer, do not appear to have any merit. In fact, the World Health Organisation has actually classified pickled foods as potentially carcinogenic.

My mantra as a physiotherapist is ‘knowledge is power’. If a client understands their condition, what contributed to it and what will help them recover, they are far more likely to achieve great outcomes. The same goes for nutrition. Be aware of whether the so-called ‘superfood’ you are eating actually lives up to the promise.

Don’t forget that correct nutrition is only one piece of the puzzle when it comes to optimal health. You also need to stay active and have an exercise routine that works for you.

Feel free to give us a call at SPS, where we pride ourselves on being experts in exercise prescription and advice.

Pilates and Lower Back Pain

Pilates for Lower Back Pain

Core Stability Exercise vs General Exercise for Chronic Low Back Pain

It has been well documented that Lower Back Pain, (LBP), is one of the most frequently reported disabilities (affecting between 60% – 80% of adults), we face in the community. Unfortunately, 40% of those suffering with LBP will not fully recover within the first 3 months.

As Physios and Pilates Clinicians, we see this type of presentation everyday.  A common back pain trigger can be from a poor lifting technique.  At Sydney Physio Solutions, we are continuously striving to find the best way of helping to improve the experience and recovery in this population group.

A recent study, published earlier this year, found that people with Lower back pain who undertook exercises to activate and gain control of their deep spinal stabilisers, aka “The Core”, had better outcomes in the first few months of treatment than those who didn’t.

In a nutshell……

  • “Core exercises”, (learning specific & correct activation of your muscles supporting the spine and pelvis), provide a better outcome during the first 3 months of intervention compared to general exercise alone for people with LBP.1
  • People with Lower back Pain (LBP) display a decreased activation or delay in Transverse Abdominus (deep abs), and Multifidus (supporting spinal muscles). Thus core exercises consist of regaining the strength of these muscles through specific training. 1

At Sydney Physio Solutions, all of our Pilates Clinicians are physios, and thus have the ability not only to assess your core in real time via Ultrasound, but can also guide you personally on what exercises will help and how to progress these if you suffer from lower back pain. Using this technology, you can guarantee you are receiving the most up-to-date, effective and evidenced based approach to managing your pain.

Back Pain Exercises: Low Back Pain Relief & Hamstring Strength for Squats

Looking for Physio in Sydney CBD to treat your lower back pain – Sydney Physio Solutions have two centrally located clinics in Sydney CBD as well as a clinic in Chatswood.

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.

Pain Triggers – Shoulder Rides

 

shoulderride2

 

Most parents know kids can cause pain… literally. Lifting and carrying children can result in stress and strain on the parent’s body, back, shoulders and neck. The shoulder ride is a typical suspect. Despite being great fun for the child, it can quite literally be a pain in the neck for the parent as sometimes it is just quicker and easier to pick up a child when walking a long distance.

So how can a parent minimise the stress and strain on their own bodies?

  • If you absolutely insist on lifting a child up onto your shoulders, try having them stand on a higher (make sure it is safe!) surface such as a table, so that they are at the correct height. Remember its always much better to lift with your legs, rather than your back and this is no different
  • There are carrying devices on the market to assist in carrying children on the back or shoulders. These devices are potentially a safer option for the parent, and avoids the child needing to use a tight grip on the neck or head to hold on.
  • If carrying a baby or infant in the arms be conscious of alternating sides regularly to avoid overloading on one side only.
  • Limit the amount of time or the regularity of shoulder rides.
  • Know when to say no. Don’t attempt it if you are tired, or sore.
  • Know your limits. At some point in time your child will be simply too big to carry. Try and explain to them that it is no longer safe to keep carrying them.
  • Learn a few smart stretches to help keep you limber. Your friendly physiotherapist can guide you, or help you out if you’ve already suffered the effects before reading this advice.shoulder-rides

 

If you suffer from neck or back, it is best to commence neck treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your neck pain and muscle spasm.

If you have had neck pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as long-term stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our neck physiotherapists.

Pain Triggers – Laptop Bags

laptop-bagsCarrying a heavy laptop bag can be a common cause of lots of joint issues including neck, shoulder, lower back or forearm pain. Laptops and all the paperwork that comes along with them often weigh more than we think and can cause significant postural asymmetries and abnormal joint loading – especially if we carry them for long periods and always on the same side.

Another common culprit is us females popping our heavy laptops and papers into our shoulder handbags – not only is this bad for our shoulder and neck but also bad for our bags!  

Consequently consider using a wheeled or rolling laptop bag and swapping arms regularly backpackto help keep these aches and pains at bay. A rucksack bag rather than an over the shoulder or carrying case is also better option.

So ladies for those of you going against these recommendations its a good excuse to go shopping – happy bag hunting! 

laptop-bag

 

If you suffer from shoulder pain or neck pain, it is advisable to start shoulder treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your shoulder pain and muscle spasm.

If you have had shoulder pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as long-term shoulder stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our shoulder physiotherapists.

Tendinopathy: What is it?

Tendinopathy is a term used to described pain or dysfunction in a tendon with structural changes that are often chronic in nature. It is frequently seen in clinical practice with the most commonly affected tendons being the Achilles, patella, rotator cuff and elbow. Tendinopathy is a complex condition that can often take many months to recover from. Often referred to as tendinitis, tendinopathy does not involve inflammation of the tendon. Therefore, traditional methods used to control inflammation, such as medication, rest and ice do not seem to improve a person’s long-term function.

tendon

Tendinopathy is largely a clinical diagnosis based on symptoms and patient history. Common symptoms include:

  • Pain with tendon loading (e.g. running, throwing, jumping)
  • Reduced exercise tolerance/impaired function
  • Pain with palpation over the tendon

Tendinopathy often develops due to a change in loading through the tendon. This can be due to a sudden increase in training load or due to having a long period off exercise, leading to a weak tendon. Unlike muscle, tendons take a long time to adapt to new stimuli and can easily get damaged if changes in load are to large.

Although imaging such as ultrasound and MRI is accurate for diagnosing tendinopathy, it often does not have a direct relationship to the amount of pain you may be experiencing. It is useful in determining if any structures near the tendon may be irritated that could be contributing to your pain. Structures such as bursa can often be inflamed and which may respond to medication or short periods of rest or ice. It is not uncommon to have inflammation in structures around the tendon in addition to tendinopathy.

A review by an experienced physiotherapist in addition to some imaging can help to be as specific with your diagnosis as possible and determine the best course of treatment and long-term management.

Treatment

There are a few key points to consider when rehabilitating your tendinopathy. It is a complicated condition and will often take many months for your pain to settle and return to normal sporting activities pain free. The majority of this blog will focus on exercise, as this is the most evidence-based treatment for tendinopathy. Before discussing exercise options to improve tendon strength we will touch on a few common treatment options:

  • Rest: tendinopathy does not improve with rest as it does not improve the affected tendon’s response to load. Although pain may initially settle, it often returns with a return to activity
  • Anti-Inflammatories: these may help reduce pain levels but have no effect on tendon structure, as it is not considered an inflammatory condition.
  • Shockwave Therapy: Evidence on shockwave therapy is mixed, mostly due to the type of study conducted. The best evidence is in plantar heel pain (e.g. plantar fasciitis). It does seem to have a good short-term effect on pain and therefore is often a useful adjunct to exercise.
  • PRP Injections: Overall, there is poor evidence for any type of injection in tendinopathy. Currently one of the most common options is a PRP injection. PRP injections are derived from spinning a blood sample to separate the platelets that contain growth factors and promote healing. This is then injected into the tendon to stimulate healing. In good quality studies PRP does not perform better than placebo. In fact, it was removed from the Medicare rebate scheme due to lack of evidence and the high cost. It therefore should only be considered a last resort in stable tendon pain.

Tendons need to be loaded progressively so that they can adapt and develop a tolerance to each individual’s specific activity. In most cases, tendinopathy will not improve without this increase in loading. Although rest does not heal tendons, there is a need to modify some aggravating factors in order to allow the tendon time to adapt to the exercises. Exercise needs to be individualised based on your individual pain, function and goals. Current evidence supports a progressive exercise program that is progressed over months according to each person’s response. These programs can be broken down in to 4 key phases:

  1. Isometric Exercise (pain relief): recent evidence shows long sustained holds for 5×45-60sec may have a pain relieving effect in tendinopathy.
  2. Strength: once symptoms allow, progressing to specific heavy, slow exercises of 4×6 up to 3x per week allow for muscle growth.
  3. Power & Speed: reducing weight from phase 2 but increasing speed, up to a maximum of 3 sessions per week.
  4. Sport Specific: every 2-3 days while continuing strength exercises.

As you can see, tendinopathy is a complicated condition that requires a very clear and multifaceted approach to achieve the best possible outcomes. Unfortunately, there is no shortcut or quick fix to treating tendon pain. Exercise is the best medicine, with everything else being an adjunct to a well planned, personalised and progressive rehabilitation program. It is important to get a review by a therapist confident and experienced in treating tendinopathy as it can often be a debilitating condition that will hang around for months without appropriate treatment.

Knee Joint Cartilage Tears

 What is a Knee joint Cartilage Tear?

The two types of knee joint cartilage tears  include traumatic and degenerative tears.

Traumatic tears occur through twisting injuries of the knee and degenerative tears occur over time through wear and tear on the joint.

 Do Cartilage Tears heal?

It depends on the location and severity of the tear. The meniscus (cartilage) generally has poor blood supply. The outside one third portion of the meniscus had some blood supply, which may give tears in this location a chance to heal. However, the inside two thirds has no blood flow, therefore tears in this region have no chance to heal. These tend to require arthroscopic surgery.

How do you treat knee joint cartilage tears?

 Small meniscal tears, or tears in the area receiving good blood supply can respond well to physiotherapy.

Physiotherapy treatment for meniscal tears aims to decrease the pain and inflammation in the joint, restore normal movement around the joint and muscle length. Physiotherapy will improve the strength of the hamstrings and quadriceps and hip muscles. Physiotherapy will also correct any longstanding biomechanical issues surrounding the knee joint.

Overall, the knee joint will improve in function and will have a reduced chance of re-injury.

How long does a knee joint cartilage tear take to heal?

MeniscKnee painal tears generally take 6-8 weeks to heal, although some meniscal tears require surgery. Your physiotherapist is the best person to guide you on the most appropriate course of action to recover. Typically, avoiding high impact activities that stress the joint whilst seeing your physiotherapist is key to a optimal outcome.

If you suffer from knee pain or knee injurt, it is advisable to start treatment straight away.  Your physiotherapist has numerous tricks that can help to quickly relieve your knee pain and muscle spasm.

If you have suffered knee pain or stiffness for a month or more, your GP may be able to refer you to a physiotherapist in Sydney as the causes and treatment of knee stiffness can be treated effectively at any time.

If you are not sure what to do, please contact Sydney Physio Solutions for advice or to make an appointment with one of our knee physiotherapists.

 

 

Sleep Habits

Physios are often asked about the best position to sleep in, and what is the best mattress or pillow to use. Unsurprisingly, there is no one answer. However, sleep is obviously a crucial time to allow the body and mind to recuperate. Here are a couple of tips that I often advise.

dog upside down

In patients with low back pain, especially if it is one sided and referring into the leg, I advise them to sleep with their sore side up and a pillow/s between the knee to unload the spine. This also works very well for hip pain, particularly bursitis, as it removes the tension of the leg from the hip.

Mattresses are often a great source of contention. The main advice that I give to patients is to make sure they feel comfortable and supported and check that they are not waking up in a valley in the morning! This would indicate that it may be time for a new mattress. This is where you need to have a trade-off between feeling comfortable but also supported. When patients are deliberating between a slightly softer or firmer mattress I generally recommend the firmer mattress as they tend to soften over time anyway.

Pile_of_pillows

When it comes to neck pain and pillows, I advise patients to select a pillow that maintains a neutral neck position. If you are unsure of what a neutral position is then you may want to consult your physio. The pillow chosen will vary depending on whether the person is a stomach/back/side sleeper, but it will also vary based on the person’s size and natural spinal curvature.

In general, side sleepers will probably need a high profile pillow, whereas back sleepers will likely only need a low profile pillow or sometimes no pillow at all (or a rolled up towel behind the neck).

When a patient is suffering from acute neck pain and finding it difficult to find a position of comfort, I generally recommend lying on your back with a McKenzie cervical roll under the neck. This usually keeps the neck in a minimally stressful position. If the patient also has associated arm pain, then I may advise them to have a pillow under their arm to support it and take the weight of the arm off the neck.