1. Pelvic floor muscle assessment – our Pelvic floor muscles are the muscles that form a sling at the bottom of our pelvis. They support important organs such as our bladder, uterus and bowel and also play a vital role in our control of continence. If you have had a vaginal birth, the pelvic floor muscles may have been stretched or torn during the process. Just because you’ve had a C-Section does not mean you are in the clear too!! Pelvic floor weakness can occur just by carrying your baby for 9 months. A women’s health physiotherapist can assess your muscles in regard to tone (how are they at rest), your contraction ability (how are they when you turn them on, when you try to hold the contraction and how quickly do they contract.)

2. Abdominal muscle assessment – measurement of your DRAM separation and providing an individualised strength-based program to help your abdominal muscles recover.

3. Prolapse risk assessment – occasionally due to pelvic floor muscle dysfunction (tears or weakness) some ladies may be at risk of developing a pelvic organ prolapse (slipping forth of the pelvic organs from their original place.)

4. Return to exercise management – getting you back to exercise effectively and safely!! Whether this be a Pilates program, gym program or cardio program.

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Key Point

Pregnancy is safe and healthy to do in low-risk and uncomplicated pregnancies, if you have a high risk-pregnancy it is important to get clearance from your Obstetrician prior to starting a new exercise program.

30 minutes of moderate intensity exercise on most days is what we aim for.

Why should I exercise during pregnancy?

• Helps you stay at a healthy weight
• Makes you stronger and fitter – good for coping with pregnancy, labour and better post-birth outcomes
• Helps to decrease with pregnancy related pains eg. back pain
• Reduces the chance of developing Gestational Diabetes

What exercise is safe?

• If you have not previously been exercising prior to pregnancy, ensure to start off gently – eg Pilates, walking, swimming
• Avoid contact sports or anything with a high risk of falling – eg netball, horse riding
• Avoid overheating – eg saunas, ‘Hot Yoga’
• Avoid high impact activity, unless cleared by your Obstetrician or women’s health physiotherapist to do so
• Ensure to keep hydrated, protect your pelvic floor, and avoid exercising if it is causing pain

Is Pilates good during Pregnancy:

Pilates is a great way to help:

• Strengthen your core muscles to avoid large abdominal separation post birth
• Strengthen your inner thigh and glute muscles to help reduce pelvic and lower back discomforts during pregnancy
• Strengthen your pelvic floor and ensure it is kept from being overloaded
• Improving your upper body strength to help with lifting baby post-birth
• Improving your breathing and relaxation
• Improve your mobility especially in your upper and lower back

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It’s often stated that knee braces can cause muscle wasting, if used for too long. However, there has been very little research into this. A study by Callaghan et al. (2016) assessed 108 patients using braces for osteoarthritis of the patella-femoral joint (knee cap). They found that the maximum voluntary contraction of the quadricep (thigh) muscles did not reduce with brace use.

All studies have limitations. This study only assessed a flexible knee support, so we can’t apply the findings across all knee braces – they would need to be assessed separately.

 Is it ok to use a knee brace all the time?

In clinical practice our advice to patients is to only use a brace if it reduces pain and improves function. A brace may be prescribed in the early stages of an injury and as symptoms improve, it is recommended that the use of brace is reduced. Long term, knee braces should only be used around activities that can increase the load in the knee and aggravate the joint such as prolonged walking, sports, gardening, etc.

Knee braces should be prescribed to ensure you are using the correct brace for your injury or knee pathology.

What should you do?

Using a flexible brace appears not to have a detrimental effect on the quadricep muscles in the short term. However, anyone wishing to wear a knee brace longer than this period should discuss this with a physiotherapist. The Physiotherapist at SPS are highly experienced and can assess the appropriateness of using a brace as well as ensuring it is being used appropriately for your knee pathology.

Are there knee braces for ACL injuries?

There are specific knee braces designed to assist with ACL injury. However, it is important to seek the advice of an experienced physiotherapist before using one of these braces. Whilst a brace may assist you, it is crucial that you fully rehabilitate your strength and balance before returning to sport following ACL injury to reduce the risk of re-injury of injury to the other knee.

Are there knee braces for osteoarthritis?

There are braces that are specifically designed for assisting with osteoarthritic pain. They range from several hundred dollars to over a thousand dollars in price. $1000 is a lot of money but compared to the cost of surgery and post-operative rehabilitation, may be a good alternative. The most expensive braces, often ‘unloading braces’, aim to unload the side of your knee that has the most arthritis to alleviate pain with activity. They do not fix your knee, they just try to slightly alter the loading pattern which may be enough to reduce your pain. These braces should be fitted by a professional to get the best effect.

Reference: Callaghan M, Parkes M, and Felson D 2016 The Effect of Knee Braces on Quadriceps Strength and Inhibition in Subjects With Patellofemoral Osteoarthritis

Journal of Orthopaedic and Sports Physical Therapy

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There are four major bones in the knee, including:

• the femur
• the tibia
• the fibula
• the patella

But did you know about the fabella!  The fabella is a tiny bone that sits in the back of the knee in about 10-30% of humans.  It’s usually embedded in the gastrocnemius muscle and you wouldn’t even know it’s there until you got an x-ray!

What are the ligaments that support the knee?

This is an easy question with a complex answer!  If you consider all structures that are considered ‘ligaments’ in some context, there are 13.  They include:

Extracapsular ligaments (those outside the joint capsule)

• medial retinaculum
• lateral retinaculum
• patellar ligament
• lateral collateral ligament
• medial collateral ligament
• oblique popliteal ligament
• arcuate popliteal ligament

Intracapsular ligaments (those inside the joint capsule)

• anterior cruciate ligament
• posterior cruciate ligament
• anterior meniscofemoral ligament (Ligament of Humphrey)
• posterior meniscofemoral ligament (Ligament of Wrisberg)
• transverse ligament
• meniscotibial ligaments (coronary ligaments)

Why does my knee hurt when I go downstairs but not upstairs?

Pain at the front of the knee is often due to abnormal forces passing through the kneecap joint, and biomechanical studies show us why sometimes we experience pain down, but not up, stairs.  Compared to normal walking and walking up stairs, down stairs puts the most load through the kneecap joint and is therefore more likely to be a problem.

• Walking – 261% of body weight
• Up stairs – 316% of body weight
• Down stairs – up to 346% of body weight

The post Things you didn’t know about knees! appeared first on Sydney Physio Solutions.

Does it feel like there is a ball squashed up between your toes when there isn’t? A pebble under the ball of your foot? Tingling or numbness in the toes?  All these signs and symptoms may be linked to irritation of a nerve in your foot, officially called a “Morton’s Neuroma”. This scary sounding condition is typically caused by the thickening of tissue around the plantar nerve, where it travels between the 3rd and 4th toe, compressing the nerve.  More rarely, it can occur between other toes.

What are the causes?

Symptoms such as those described above, will vary between people.  Whilst the condition itself develops over time, the symptoms are typically aggravated by weight bearing on the involved foot, even for a short period of time. Sudden increase in stress or load on the foot may increase symptoms.

Common culprits for this stress may be shoes that are too tight across the width (therefore squashing the mid foot area) and/or too high (which put more load through the toes). People with changes to their foot posture (e.g. bunions/flat feet; hyper mobile feet) may be more predisposed to Morton’s neuroma.

How do I know if I have a Morton’s Neuroma?

Not all pain in this region of the foot is caused by a Morton’s Neuroma.  Other conditions such as metatarsalgia (inflammation of the joint that connect the toe to the foot) or a bone stress-reaction could be alternative diagnosis.  Seeing your physiotherapist if you have foot pain, is the best way to ensure you get an accurate diagnosis and help you address your pain.  Your physiotherapist can perform an assessment, help you organise further investigation if needed, and provide treatment to improve your condition.

How Do I treat a Morton’s Neuroma?

Sometimes the obvious answer is the best one…simply offloading the stress and pressure to the forefoot can reduce your pain – if possible, try wearing footwear that doesn’t force all the toes heavily together.  Failing that, certain types of orthotics (foot supports) can be trialed to support the arch and spread the toes – this can offload the building pressure.

If your condition does not improve and you have trialed appropriate conservative options, such as those detailed above, you may be referred to a specialist. Injections are used to reduce the irritation and surgery is a final resort.

Does a Morton’s Neuroma go away on its own? Can it be cured?

You will likely require some help in managing your symptoms. Physiotherapy can be beneficial in helping you address the mechanics that may contribute to the condition and to strengthen the muscles of the feet and lower limb.

Morton’s Neuroma exercises

You may need some exercises to help with your problem.  Physiotherapists are experts in exercise prescription and can help you plan appropriate strategies to get you back on track.

At Sydney Physiotherapy solutions our physiotherapists are experts at managing foot conditions such as Morton’s Neuroma. If you are suffering from foot pain, an early diagnosis and appropriate management will help keep you on your feet.

The post Pain in the foot? Could it be a Morton’s Neuroma? appeared first on Sydney Physio Solutions.

• A deep layer of muscle which attaches from the pubic bone to the tailbone and forms a sling/hammock that provides support for the bladder and bowel.
• Imagine the pelvic floor as a muscular elastic trampoline that moves up and down in a dome like shape as we contract and relax the muscle.

Why is the pelvic floor important?

• It supports the bowel, bladder and uterus and prevents problems such as incontinence and prolapse.
• It provides lumbo-pelvic stability

What causes it to be weak?

There are many reasons why your pelvic floor may be weak. A few examples include:

1. Childbirth
2. Persistent heavy lifting with weak abdominal muscles
3. Menopausal hormonal changes
4. Prostate problems
5. Obesity
6. Excess coughing

How do I activate it?

There are a number of different visualisation and imagery techniques used to try and help activate the pelvic floor:

• Imagine drawing up a 5 cent coin slowly with a gentle contraction
• Imagine you are gently trying to pause your flow of urine mid flow
• Stop yourself from releasing wind whilst keeping your glut muscles relaxed

** When you are activating your pelvic floor correctly, it should feel like the muscles around your front and back passage are gently lifting up towards your belly button. **

When activating your pelvic floor, try and activate it in a number of different positions including:

• Sitting
• Standing
• 4 point kneeling
• Lying on your back with knees bent

How should I train my pelvic floor?

Step 1:

Once you can activate your pelvic floor effectively it is important to build up some endurance of these muscles. Try the following program:

• Hold the contraction for 3-5 seconds and then release
• Repeat the contraction and hold for 3 sets of 10 repetitions
• 3-4 times per day for 4 weeks
• Alternate this with quick contractions and release for 3 sets of 10 repetitions

Step 2:

• Incorporate these exercises into a more global exercise programme like Pilates classes
• Remember, the pelvic floor is only one third of an important set of deep core musculature and so needs to work well in combination with both the Transverse Abdominis and Multifidus (these are the other two other important deep core muscles!)

Important points to remember when completing these exercises:

1. You should feel your pelvic floor muscles lifting up and inwards rather than downwards
2. There should be no movement or contraction of your glut, core or hip muscles
3. Keep breathing throughout the exercise and try not to hold your breath
4. The contraction should only be a 3/10 – NEVER GRIP your pelvic floor. Instead it should feel like a gentle sensation of lifting.

Still unsure?

To be 100% sure that you are effectively activating your deep core, your Physiotherapist can use Real Time Ultrasound (RTUS) to get a detailed image of how your muscles are working. If you would like to book in for a comprehensive Pilates assessment, please contact one of our clinics today.

The post The Pelvic Floor appeared first on Sydney Physio Solutions.

How do I choose a pillow?

Choosing the right pillow is as individual as you. Things to consider when choosing a pillow are your size, shape and the position you sleep in.

From here you want to find a pillow that allows your neck to remain in a neutral alignment, this is where the size of the pillow is important.

If you are a back sleeper you will likely require a thinner pillow to ensure your head is not pushed forward into a flexed position.

Side sleepers generally require a thicker pillow or even 2 depending on how broad your shoulder are, in order to achieve a neutral position. The diagram below demonstrates this.

How often should I change my pillow?

It is also a good idea to check your pillow every 12-18 months as depending on its quality and fill it may have lost its shape and no longer provide the support you need.

I have a good pillow but still get neck pain. What next?

Although an incorrect pillow is rarely the sole cause of neck pain it can certainly contribute to the issue. If you suffer from neck pain or have any questions regarding your pillow, contact the team at Sydney Physiotherapy Solutions to make an appointment at either of our Sydney CBD physio clinics or at our Chatswood Physiotherapy clinic.

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The acronym PRICE (Protection, Rest, Ice, Compression, Elevation) has long been central to the acute management of soft-tissue injuries despite any significant high-quality evidence to support the different components or collaborative approach.

Recent literatures have advocated the use of loading in the management of musculoskeletal disorders. Bleakley et al (2012) have discussed changing PRICE to POLICE, or more specifically changing the rest component with optimal loading.

Why the change?

They argue that whilst rest is sometimes warranted, it should be of a limited timeframe. Short term rest may be used to protect the joint/tissue from further aggravation. However, longer periods of unloading have been shown to be detrimental in the recovery of soft tissues.

Progressive loading is more likely to restore movement, strength and assist with tissue restructuring and healing. Overloading can also have a negative effect on healing, thus finding “Optimal loading” is better placed to guide the loading management of an acute injury than rest.

What is “Optimal load”?

Optimal loading means gradual rehabilitation to promote tissue remodelling. The use of loading within the management of musculoskeletal disorders is important through all stages of the injury and it will vary based on the anatomical structure that is injured. Khan (2009) introduced the term “mechanotherapy” as “therapeutic exercise prescription specifically aimed at promoting the repair or remodelling of injured tissue”.  The mechanotherapy used on each person needs to be individualised to ensure that the tissue is not stressed to aggressively, in order to reduce the risk of re-damaging.

How do I know I have the right balance of rest and load?

The difficult clinical challenge is finding the balance between loading and unloading during tissue healing as the dose needs to be individualised to each person.

Each injury will have a set of milestones that you will need to try and achieve in order to ensure you are returning to full function.  At SPS, all of our physiotherapists are highly experienced and recognise the appropriate stages of tissue healing that each person should be at. Having the Physiotherapist give you an accurate diagnosis of you injury, will mean they can guide you through the “optimal loading’ phase and ensure you are doing the right rehabilitation and goals are being achieved.

Reference: Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE. Br J Sports Med 2012; 46: 220
Khan KM, Scott A. Mechanotherapy: How physical therapists’ prescription of exercise promote tissue repair. Br J Sports Med 2009; 43: 247-251

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The most common type of knee problem is pain that occurs around the front of the knee or knee cap, also called the patella. This pain is often referred to as Runner’s Knee, which we call a “bucket” diagnosis because it includes several different causes. It has other names including patellofemoral pain syndrome (PFPS), anterior knee pain syndrome (AKP), and chondromalacia patellae (softening of the cartilage on the back of the kneecap).

The pain of Runner’s Knee usually comes on as the load applied to the knee is increased, or the muscles that support the knee have become weak. A common time for runner’s knee to develop is when you’re training for a race like a half marathon or marathon. But despite the name, it has many other triggers and often affects people who don’t run at all.  Anything that increases load around the knees can bring it on, including walking, stairs, cycling, weight gain, squatting, lunges etc.

How do I know if I have Runner’s Knee?

If you have pain around the front of your knee and haven’t had a traumatic injury like a fall or bad twist, the chances are you probably have Runner’s Knee.  It’s VERY common. A recent study published in 2018 reports that each year, nearly 1 in 4 people will experience this type of knee pain. It usually hurts during activities that stress the knee like stairs, squatting, running, jumping, and sitting for extended periods (theatre sign), and feels better with rest, ice and taping or bracing.  Often, but not always, there may be some grinding and clicking of the kneecap. If there is significant swelling, your knee feels like it’s giving way, or it locks up on you, you may have some other things going on that need to be looked at more closely.

What are the causes of Runner’s Knee?

As is often the case, there a number of potential causes or contributors:

• biomechanical problems stemming from the hips, pelvis and/or feet;
• weakness of the supporting muscles, particularly the quadriceps and gluteals;
• a rapid increase of repetitive loading, or a single significant load beyond the capacity of the kneecap joint;
• inadequate range of motion or flexibility of the hips, knees, hamstrings, ankles, or calf muscles;
• changes to the cartilage affecting the back of the kneecap;
• trauma such as fall onto the knee.

How do you treat Runner’s Knee?

There are some things you can use to reduce the pain of Runner’s Knee, including:

• ice;
• taping or bracing;
• anti-inflammatory medications;
• short periods of rest or reduction of load;
• cross training;
• manual therapies such as massage, dry needling and joint mobilisations.

Ultimately, the goal is to fix the underlying cause, so a full biomechanical assessment and treatment plan is essential.  This will include a combination of:

• stretches of the hips, hamstrings, calves etc.;
• strengthening exercises, particularly for the quadriceps and buttock muscles;
• myofascial release of areas such as the iliotibial band;
• movement retraining to fix underlying biomechanical problems;
• load management and activity planning;
• footwear changes and occasionally orthotics;

How do I prevent Runner’s Knee?

A few simple strategies will give you the best chance of avoiding this extremely common problem:

• maintain a good weight range;
• plan your training well and make sure that increases in load are slow and steady;
• implement a basic stretching and strengthening regime for the most-common problem areas, including hip mobility, buttock strength and control, quadriceps strength, ankle mobility and hamstring flexibility;
• get an expert to assess and tweak your running style, but make sure the changes you make are only very subtle;
• wear appropriate footwear for exercise and activities that stress the knees, and don’t let your running shoes get too old…about 6-12 months or 800km is reasonable.

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In regards to the shoulder injuries specifically, it is looking like (from the news reports) that South African Duminy’s return is going to be delayed as he continue to rehabilitate his shoulder after his shoulder surgery in October, and Australian’s fast bowler Mitchell Starc has also been currently ruled out of the upcoming India trip due to a left pectoral injury (where he will no doubt will be currently focusing on shoulder rehabilitation exercises as part of his recovery).

What is the role of the shoulder in cricket?

When throwing, the shoulder is required for both stabilization and generation of power. It has been shown that with bowling, the optimum height is dependent on the mid back and shoulder coupling to optimise the throwing velocity and acceleration curve. The goal when throwing a ball is often to throw hard, accurately and effectively. Therefore, to achieve optimal performance, having a high level of shoulder strength and control is very important.

Why can shoulder pain occur with overhead throwing?

In shoulder injuries of bowlers and fielders, it has been found that 90% of them are from overhead throwing actions with possible causes being reduced shoulder blade control (players presenting with a shoulder blade turning down), shoulder restriction with turning the shoulder inwards, and reduced strength of the muscles stabilising the shoulder (the rotator cuff). It has been found that most cricketers have an increase in movement with turning the shoulder outwards.

Why do I need to think about with my cricket training volume?

Australian cricket publications have shown that shoulder tendon injuries are at risk of injury when there are sudden increases in workload, and that tendons are at lowest risk of injury when performing consistent workloads.

Gradual upgrades of training are recommended particularly at the start of the bowlers career to reduce risk of bone stress injury, and it has been shown that the playing short form cricket increases the risk of muscle injuries. It has also been shown that there is often a 3-4 week delay between high training volume (lots of hard throws at practise) and the onset of injury.

How should I prevent sustaining a shoulder injury during cricket season?

It is really important during training to limit the number of hard throws, not to over or under train and during the off season, and to really focus on strengthening your rotator cuff and muscles surrounding your shoulder blade.

If you need an assessment, strengthening programme, or would like to attend a clinical rehabilitation class addressing your shoulder give us a call.

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