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Neck Health and Physiotherapy

30/8/2019

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Neck Health and Physiotherapy


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Our social media covered neck problems this week. The neck can be viewed as a collection of joints and muscles that support and move the head on neck. Of course, they also provide vital pathways of food, breath and nerve system function for our vital organs and extremities.
Neck muscles, joints, ligaments have a myriad of intricate sensors built in to feedback to the brain about balance and movement, not just of the head and neck but the whole body. Therefore we need to think of the neck also as organ of perception. The neck has a key role in perception of movement force, speed, direction and orientation of the body in space.

Feedback Loops

Feedback loops between the eyes, inner ear canals, the neck liaise with the control centres in the brain to keep our balance, enable us to walk or run with no visual jolting like a video cam and enable us to smoothly track moving objects of varying speed.
Neck pain, joint stiffness, or neck muscle fatigue can interfere with these mechanisms leaving us to feel unsteady, in pain and other symptoms such as headache(1) migraine(2), visual disturbances, tinnitus, radiating arm pain or jaw discomfort to name a few of the symptoms. Neck pain is a leading cause of disability worldwide (3).

Reasoned help is at hand for every neck from physiotherapy!

Various physiotherapy treatments have beneficial effects in reducing pain and disability in the short and long term. These comprise movement techniques of the neck joints and nerve tissues called manual therapy. Specific exercise therapy is also beneficial in retraining, strength, endurance, contraction timing, and therefore control. For symptoms of unsteadiness and dizziness arising form neck problems, specialist head position and control retraining is used effectively in neck pain, whiplash and post-concussion(7). Research into these treatments shows cost effective benefits with minimal risks (4)(5). Combining different physiotherapy treatments into a tailored individual programme based on clinical assessment is the best approach(6).

References:
1 ) Florencio LL et al. (2015): Headache: The Journal of Head and Face Pain
2) Florencio, LL., et al. (2019): Journal of Orthopaedic & Sports Physical Therapy 
3) Vos, T., et al. (2017): The Lancet
4) Fredin, K., Lorås, H. (2017): Musculoskeletal Science And Practice
5) Coulter, ID., et al. (2019) Pain Physician
6) Fella, D., Hodges, PW. (2017) Exercise Sports Science Reviews 
7) Schneider, KJ. (2019) Musculoskeletal Science and Practice

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ACL Injury: Does It Require Surgery?

23/8/2019

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ACL Injury: Does It Require Surgery?


What are the General Guidelines in Australia Following an ACL Tear

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Australia has the highest incidence rates of ACL reconstructions following an ACL tear in comparison to any other country. Approximately 90%(1). of ACL tears are surgically repaired in Australia compared to 50% in other countries such as Northern Europe.
The decision to have an ACL reconstruction can be difficult and several factors need to be considered before heading down the surgical path including the degree of injury, symptoms of instability and your activity levels.
In general, if you are a younger athlete wanting to get back into high-level sports that involve rapid changes of direction such as soccer or netball, most people will go down the surgical pathway to have an ACL reconstruction(1).

Why are ACL Reconstruction Rates so High in Australia

It was initially believed that having an ACL reconstruction prevents further damage at the knee, diminishes the risk of getting osteoarthritis in the long term and increases the return to sport rate. However, recent studies have shown that there are no benefits to having an ACL surgically reconstructed compared to a high quality structured rehabilitation program alone in terms of pain, mental health, return to sport rates, osteoarthritis and damage to other structures at the knee.(2-8)

Can You Function Without an ACL?

Research(9) has shown that if a torn ACL is not surgically repaired, it may actually heal by itself. Even complete full thickness tears can reattach(10), which was previously thought to be impossible due to a poor blood supply to the ACL.
Also, If the ACL doesn’t quite reattach it can become a redundant ligament by undergoing an intense rehabilitation program comprised of strengthening, balance and proprioception training to strengthen the surrounding muscles and ligaments.

Are There Any Risks Involved with an ACL Reconstruction

There are risks involved with an ACL reconstruction as there is with any surgery including an increased risk of developing blood clots and infection. Additionally, the ACL graft is harvested from either the hamstring or patella tendon so there is risk of having permanent damage, pain and dysfunction at those sites following an ACL reconstruction(11).
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So, should I Have an ACL Reconstruction?

Anyone with an ACL injury should follow world’s best practice and that is to undergo an intense, graded individualised exercise program supervised by your physiotherapist for three months and then re-evaluate having an ACL reconstruction based on signs and symptoms.
If by the end of the three months your knee continues to feel unstable and it’s affecting daily activities, or you’ve tried to get back into sport and the knee doesn’t feel stable then make the decision to have an ACL reconstruction.
There is no harm in giving conservative management a go first and then having an ACL reconstruction later down the track. Research(12). shows that you will get the best outcome if you take this approach as getting the knee as strong as possible before surgery improves the recovery process after surgery so it makes sense to hold off on surgery and trial non-surgical management before going under the knife.

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References

1. Zbrojkiewicz D, V.C., Grayson JE, Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust, 2018. 208(8): p. 354-358.
2. Smith, T.O., Postle, K., Penny, F., McNamara, I., & Mann, C, Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. The Knee, 2014. 21((2)): p. 462-70.
3. Delincé, P. and D. Ghafil, Anterior cruciate ligament tears: conservative or surgical treatment? Knee Surgery, Sports Traumatology, Arthroscopy, 2013. 21(7): p. 1706-1707.
4. Grindem, H., et al., A pair-matched comparison of return to pivoting sports at 1 year in ACL-injured patients after a nonoperative versus operative treatment course. The American journal of sports medicine, 2012. 40(11): p. 2509-2516.
5. Nordenvall, R., et al., Cruciate Ligament Reconstruction and Risk of Knee Osteoarthritis: The Association between Cruciate Ligament Injury and Post-Traumatic Osteoarthritis. A Population Based Nationwide Study in Sweden, 1987–2009. PLOS ONE, 2014. 9(8): p. e104681.
6. Sanders, T.L., et al., Is Anterior Cruciate Ligament Reconstruction Effective in Preventing Secondary Meniscal Tears and Osteoarthritis? The American Journal of Sports Medicine, 2016. 44(7): p. 1699-1707.
7. Gupta, R., et al., Delay in surgery predisposes to meniscal and chondral injuries in anterior cruciate ligament deficient knees. Indian Journal of Orthopaedics, 2016. 50(5): p. 492-498.
8. Filbay, S.R., Early ACL reconstruction is required to prevent additional knee injury: a misconception not supported by high-quality evidence. British Journal of Sports Medicine, 2018.
9. Costa-Paz, M., et al., Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study. Clinical Orthopaedics and Related Research, 2012. 470(4): p. 979-985.
10. Fujimoto, E., et al., Spontaneous healing of acute anterior cruciate ligament (ACL) injuries – conservative treatment using an extension block soft brace without anterior stabilization. Archives of Orthopaedic and Trauma Surgery, 2002. 122(4): p. 212-216.
11. Konrath, J., Vertullo, C., Kennedy, B. A., Bush, H., Barrett, R., & Lloyd, D. , MorphologicCharacteristics and Strength of the Hamstring Muscles Remain Altered at 2 Years After Use of a Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction. . American Journal of Sports Medicine, 2016. 44(10): p. 2589–2598.
12. Eitzen, I., et al., A Progressive 5-Week Exercise Therapy Program Leads to Significant Improvement in Knee Function Early After Anterior Cruciate Ligament Injury. The Journal of orthopaedic and sports physical therapy, 2010. 40(11): p. 705-721.
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Plantar Fasciitis: 3 Common Mistakes That Keep People in Pain

16/8/2019

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Plantar Fasciitis: 3 Common Mistakes That Keep People in Pain


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​1. Waiting to Treat Your Plantar Fasciitis

If you suspect that you have plantar fasciitis, it’s important to seek treatment quickly from a physiotherapist. Continuing to participate in activities that aggravate the injury such as walking, running, or jumping can make micro-injuries worse, allow the arch to flatten further, and ultimately delay healing. However, avoiding all activity on the foot and resting on the couch to binge watch a new series on Netflix is also detrimental to adequate healing. 
 
What to do instead: Make an appointment with your physiotherapist in the early stages of injury to prevent further damage and start effectively rehabilitating the foot with a graded exercise program.Strengthening and stretching the calf and foot muscles, orthotics, icing and taking relative rest from aggravating activities is one of the best ways to avoid costly and more invasive medical interventions down the line.
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2. Incorrect Use of Ice and NSAIDs

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Although ice and non-steroidal anti-inflammatory drugs (NSAIDS) like Nurofen can be very effective in relieving pain associated with plantar fasciitis, it’s possible to use them incorrectly. Using NSAIDs to relieve pain before engaging in activities that will flare up the injury such as running or a game of netball as this will only mask the pain and delay healing [1]. The inflammatory pain is a signal that the tissues are sprained and it’s important to respect it and treat it as needed with NSAIDs and not as a way of pushing through pain. Now let’s talk about ice. It’s important not to apply ice directly to the skin and don’t leave ice on the injured area for any longer than 20 minutes at a time as this can cause tissue damage and problems with circulation [2].  
 
What to do instead: It’s important to combine NSAIDs with relative rest from aggravating activities to ensure a speedy recovery. If you aren’t in much pain, avoid taking NSAIDs as these drugs will prevent you from knowing what activities aggravate the foot which can cause further damage. When applying ice to the skin, use a barrier between the skin and the ice such as a towel and keep ice applied to the area for between 10 and 20 minutes at a time to maximise the benefits of ice.

3. ​Inadequate footwear 

If you like to wear high heels, this section is for you. Wearing high heels such as stiletto heels and other ultra high heels can be shoe-icide to your poor foot! These shoes raise the arch of your foot to an unnatural angle which destabilises the foot and puts a significant amount of strain on the plantar fascia. So now you might be thinking if flats are the best shoe to wear for plantar fasciitis and the answer is no. Flats create the opposite problem for your feet, they provide minimal support to the foot arches which means the plantar fascia is not able to distribute the weight and the impact of movement efficiently. Without proper support, the plantar fascia can be further strained which is bad news for plantar fasciitis. 
What to do instead: While there aren't any shoes specifically designed for plantar fasciitis, there are some smart features to look out for when purchasing a new pair of supportive shoes. Health experts [3] recommend choosing shoes with good arch support, supportive cushioning, shock-absorbing soles, and a deep heel cup to keep plantar fasciitis symptoms at bay. It's generally wise to choose a heavier shoe, since lightweight shoes don't deliver much support and if you can bend your shoe in half like a burrito then the shoes are unlikely to provide any more support than being barefoot. Asics and New Balance are two popular brands of shoes that provide a high level of support to the foot.
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If you have any questions regarding plantar fascia or any other injury, like the post,
​or call our clinic reception on 9533 5305

References      
1.  Rainsford KD (2013) Ibuprofen: from invention to an OTC therapeutic mainstay. Int J ClinPractSuppl, 2:9-20.
2.  Karagounis P, Tsironi M, Prionas G, Tsiganos G, Baltopoulos P. (2011) Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols. Foot Ankle Spec, 4: 226-234.
3.  Sullivan J, Pappas E, Adams R, Crosbie J, Burns J. (2016). Determinants of footwear difficulties in people with plantar heel pain. Journal of Foot and Ankle Research, 8:40. 

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    Luca Scomazzon-Rossi APAM

    Luca graduated from a Bachelor of Physiotherapy with honours and has a background in personal training.

    Jayce Gilbert FACP, APAM

    Clinic director & Specialist Musculoskeletal Physiotherapist* in treatment for back, neck, headache and TMD (Jaw/Face) problems.

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