​A recent study found that patients with low back pain who saw a physiotherapist early, had significantly lower out of pocket healthcare costs and decreased use of opioids than those who saw physiotherapist later or not at all (1). When you consult with us, we will work with you to provide an adequate explanation of the nature and prognosis of sciatica. In the early stages, international guidelines suggest that bed rest is not recommended unless pain is significantly disabling. In fact, we will work with you to keep you physically active and doing activities that are important to you. We will combine activity with nerve relief manual therapy and nerve easing position and movements for you to do at home.

Once relief has been achieved, treatment will be more recovery focused, and involve muscle memory tasks and goal specific rehabilitation.

Physiotherapy uses a combination of evidence-based research, clinical experience and clinical training to diagnose and treat your presentation of sciatica. ​For examples of exercises that can be used, remembering that every sciatic presentation is an individual one, check out this exercise video for sciatica below: 

Have you ever felt a twinge or maybe more in your hamstring? It might have been from something as simple as running across the street to make the lights? Or maybe you were feeling good and pushing for a new personal best in the gym or out for a run? 

However it happened, you definitely aren’t alone, the incidence of hamstring strains can be as high as 5 players per season per team in some cases (1) with a reoccurrence rate of 34%. So welcome, kick your feet up (unless that hurts) and let’s do a deep dive into the best and worst ways to recover from a hamstring injury.
 
The number one mistake people will make is to not respect the injury. Depending on the degree of muscle damage that has occurred you are looking at 3 to 6 months of recovery. During this time the body will undergo processes of “cleaning up” the dead/damaged cells and generating new blood vessels and tissue. These are complex tasks that cannot be sped up, but can most certainly be slowed down! If you start to get confident with your injury and want to “test it out” or “see how it goes” you risk damaging healing tissues and setting yourself back, which is the equivalent of picking at a scab while a cut is healing.

The second mistake people will make is too much too soon. While it’s fantastic to be working with highly motivated people, the recovery for a hamstring tear is similar to that of walking a tightrope, the muscle needs to me moved and loaded enough to promote healing and recovery but not so much that we end up doing more harm than good.

The third mistake people make is forget maintenance of strength. It’s very easy to get tunnel vision when it comes to injury and focus on the injured muscle and getting it back to strength but the trap people can fall into is that they will have a fantastic hamstring but the rest of their leg (and whole other leg) has been deconditioned from doing nothing for the past few months. When this happens, it can not only delay the return to sport but it can also lead to injuries in other muscles and joints.
 
So now that we have what not to do out of the way, before we talk about what to do it is important to mention that while this is based on the best current evidence it is still a “one size fits all” type of advice so it may not be best for your exact presentation.
 
Loading the hamstring early is the first tip, (this is where the tightrope analogy comes back into play) Hickey et al. (1) showed that inclusion of early eccentric hamstring exercises led to greater hamstring strength and length down the track (2). Timeframes for recovery were similar but by choosing tailored exercise and load to put through the hamstring allowed for better results.
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It wouldn’t be a hamstring rehabilitation program if we didn’t talk about the infamous Nordic hamstring exercise… The Nordic has come under fire recently for not being a functional exercise but you could argue that what it DOES do, is does VERY well. The Nordic has good evidence as an injury prevention tool (3) and as a means of increasing muscle length and strength. For these reasons, Nordics will still remain a staple for rehabilitation but it is important to combine them with sport/task specific training.

​Osteoarthritis is the type of arthritis that happens over time as the cartilage layers change over time making them less resilient. Cartilage is the spongy tissue that coats the ends of bones in joints and acts as a shock absorber. Normally, damaged cartilage is constantly being repaired as old cartilage is degraded. When the balance between degradation and repair is thrown off, cartilage thinning occurs. As a result of cartilage thinning, the joint has more friction causing a joint to become inflamed. 

​Osteoarthritis is the most common type of arthritis, resulting from thinning cartilage levels. Rheumatoid arthritis is less common and occurs when the immune system mistakenly attacks the joint lining, causing painful swelling that can eventually result in deformity of the joint.

While there is still much to learn on the subject, some known risks factors include:

• Overweight: increases load through the knee
• Age and gender the older you are
• Gender: women over 50 are more likely to have OA than men over 50
• Genetics
• Trauma: previous injury to the knee, including sports injuries, can lead to OA Knee.
• Repetitive stress injuries: which are usually associated with certain occupations, particularly those that involve kneeling or squatting.  

​Pain is the most common symptom of osteoarthritis, occurring primarily when the joint is moved, rarely at rest. Other symptoms include:

• Limited range of motion
• Crackling sounds
• Stiffness
• Buckling or locking of the joint
• Swelling / inflamed joints

​Our clinicians can diagnose osteoarthritis of the knee based upon the symptoms you are experiencing and through a physical examination. In terms of imaging, x-rays can be done to verify osteoarthritis and show the level of progression in the joint. 

​It depends on the severity. Initial treatment is generally directed at non-invasive pain management. Pain related to joint osteoarthritis may have different causes, depending on the individual and the stage of the disease.

We ensure individualised treatment prescription based on your examination findings. This is best current practice (1).

In general, treatment is

Specific targeted exercise to address, strength, agility, coordination to cushion joints, stimulate healthy cartilage and minimise friction.
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Also included is:

• Health and behaviour modifications, such as patient education, physiotherapy, exercise, weight loss, and bracing.
• Physiotherapy is aimed towards strengthening muscles around the joint and participating in a low impact graded cardiovascular exercise program.

• Treatment options also include medication for pain relief such as anti-inflammatories or Panadol.
• Corticosteroid injections are also an option.
• Platelet Rich Plasma injections are becoming more common place with good outcomes in the short term. The longer-term benefits are still being investigated by researchers.

Unfortunately for some people, especially those whose osteoarthritis is at a more advanced stage, conservative treatment is not enough for a lasting solution.
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When quality of life and makes daily activities difficult to perform then a joint replacement maybe recommended whereby the knee joint is replaced with an artificial prosthesis. This surgical procedure has been shown to reduce pain, enhance quality of life, and improve your ability to perform everyday activities with fewer or no restrictions.