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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.
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I rolled my ankle, AGAIN!
Ankle sprains are the most common type of ankle injury and can account for up to 20% of all sporting injuries (Fong, Hong, Chan, Yung, & Chan, 2007). Poor management and insufficient rehabilitation can lead to recurrent ankle sprains, impairment of athletic performance (Yeung, Chan, So, & Yuan, 1994) and persistent disability (Petersen et al., 2013).
What happens when you roll your ankle?
An ankle sprain occurs when the foot rolls inwards, causing over stretching or tearing to the ligaments on the outside of the ankle.
Fig 1 Inversion injury of the ankle showing damage to the lateral ankle ligaments.
How bad is it?
There are 3 types of sprains which are defined by the extent of damage to the ligaments.
Grade 1: Stretched ligaments
Ligaments are stretched during a slight ankle roll. Common versions of this occur when running onto a patch of uneven grass or during an over step in tennis. You may immediately experience mild pain and a small limp. After a few minutes of rest, most people are usually able to continue their activity. Some swelling may occur within 24 hours and with appropriate management, you can expect return to preinjury state within 1-2 weeks.
Grade 2: Partial thickness tear of ligament
Ligament tearing occurs when the ankle rolls further than the ligaments can stretch. You may experience moderate pain, a limp and usually cannot continue to play. Swelling and bruising may occur within 24 hrs and weight baring is particularly painful. If you experience these symptoms, you should seek medical advice to determine the extent of damage. Depending on this, recovery can take between 2 - 6 weeks.
Grade 3: Complete rupture of ligament
Complete ligament rupture is a progression of grade two and occurs when the ankle has rolled beyond its normal limits. Initially, individuals are unable to walk on the effected ankle and can complain of it feeling “unstable”. Excess swelling and dark bruising would be expected 24 hours after injury. On a case by case basis, grade 3 sprains may require surgical intervention or up to 12 weeks of rehabilitation.
So you’ve sprained your ankle, what to do now?
After following the basic “RICE” principles (rest, ice, compress and elevation), you should seek medical advice from a physiotherapist as soon as possible. Physiotherapists are highly trained health professions who specialise in the assessment, diagnosis and management of ankle injuries.
What to expect when your see the physio?
Your physiotherapist will ask you questions regarding your injury and what symptoms you are experiencing. If pain allows, an assessment will be performed to diagnose your injury and explain the extent of damage. An accurate diagnosis is crucial in ensuring appropriate management and treatment can be provided. (Wolfe, Uhl, Mattacola, & McCluskey, 2001).
Firstly, pain and swelling management is commenced. This may involve icing, taping, bracing, crutches or a moon boot. Secondly, your physiotherapist will discuss your diagnosis and expected recovery time, as well as appropriate activity modification. Thirdly, pain free range of motion and strength exercises can commence. Fourthly, an individualised rehabilitation program will be developed and implemented. Goals and sport specific tasks will be incorporated once adequate function has been regained. Completion of your rehabilitation program results in positive outcome measures, optimal recovery and reduced risk of chronic ankle instability (Mattacola & Dwyer, 2002).
But don’t I need an x-ray?
Physiotherapists follow a set of guidelines called the Ottawa Ankle Rules that are used to determine whether a fracture is suspected (Ivins, 2006). These guidelines have an extremely high sensitivity and are used to reduce the number of unnecessary radiographs by 30-40% (Bachmann, Kolb, Koller, Steurer, & ter Riet, 2003) (Dowling et al., 2009). If your physiotherapist suspects a fracture, an x-ray will be organised.
Can I stop this from happening again?
Extensive research demonstrates that individuals who adhered to a rehabilitation program involving balance and proprioceptive training were significantly less likely to experience a recurrent ankle sprain (Petersen et al., 2013) (Hupperets, Verhagen, & van Mechelen, 2009) (Postle, Pak, & Smith, 2012). While the risk of re-injury can be reduced, unfortunately accidents can still happen.
Bachmann, L. M., Kolb, E., Koller, M. T., Steurer, J., & ter Riet, G. (2003). Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ, 326(7386), 417. doi:10.1136/bmj.326.7386.417
Dowling, S., Spooner, C. H., Liang, Y., Dryden, D. M., Friesen, C., Klassen, T. P., & Wright, R. B. (2009). Accuracy of Ottawa Ankle Rules to exclude fractures of the ankle and midfoot in children: a meta-analysis. Acad Emerg Med, 16(4), 277-287. doi:10.1111/j.1553-2712.2008.00333.x
Fong, D. T., Hong, Y., Chan, L. K., Yung, P. S., & Chan, K. M. (2007). A systematic review on ankle injury and ankle sprain in sports. Sports Med, 37(1), 73-94.
Hupperets, M. D., Verhagen, E. A., & van Mechelen, W. (2009). Effect of unsupervised home based proprioceptive training on recurrences of ankle sprain: randomised controlled trial. BMJ, 339, b2684. doi:10.1136/bmj.b2684
Ivins, D. (2006). Acute ankle sprain: an update. Am Fam Physician, 74(10), 1714-1720.
Mattacola, C. G., & Dwyer, M. K. (2002). Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train, 37(4), 413-429.
Petersen, W., Rembitzki, I. V., Koppenburg, A. G., Ellermann, A., Liebau, C., Bruggemann, G. P., & Best, R. (2013). Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg, 133(8), 1129-1141. doi:10.1007/s00402-013-1742-5
Postle, K., Pak, D., & Smith, T. O. (2012). Effectiveness of proprioceptive exercises for ankle ligament injury in adults: a systematic literature and meta-analysis. Man Ther, 17(4), 285-291. doi:10.1016/j.math.2012.02.016
Wolfe, M. W., Uhl, T. L., Mattacola, C. G., & McCluskey, L. C. (2001). Management of ankle sprains. Am Fam Physician, 63(1), 93-104.
Yeung, M. S., Chan, K. M., So, C. H., & Yuan, W. Y. (1994). An epidemiological survey on ankle sprain. Br J Sports Med, 28(2), 112-116.
The Benefits of Early Morning Exercise
Who doesn’t love the idea of being an early riser? You’re up before sunrise, into the clinic, Pilates class done, and then home in time for a quick shower and breakfast before work.
But when the alarm goes off at 5.30am, there’s easy temptation to stay under the doona. So how can you motivate yourself to get up and going before the crack of dawn? Is there any additional benefit to exercise in the morning, as opposed to late evening after work? If you’re looking to decrease stress, increase quality of sleep and boost your energy levels then read on.
We all know the importance of a good night’s sleep. But we don’t often associate the connection between exercise and sleep behaviours. A study in the US from Appalachian State University found participants who exercised early in the morning had increased levels of mental alertness and felt more energised than their evening counterparts. The same study looked at participant’s sleeping patterns. It found participants who exercised regularly at 7am or earlier, reduced their blood pressure by an average of 10% which carried through the remainder of the day. They also had an average 25% dip in blood pressure at night, slept longer and had better quality sleep cycles than those participants who exercised later in the day. Morning movers are also at an advantage over their evening counterparts as some forms of high intensity exercise 2-3 hours before bedtime is known to disrupt sleep. Simply said, the early risers were more energised during the day, and slept better at night.
One of the most important benefits of exercise, is the role it plays with our Endocrine (Hormonal) System. Our Endocrine system is responsible for the regulation of stress hormones, appetite control and immune function. The primary hormone responsible for stress is cortisol. Cortisol is secreted from the adrenal gland and is known for increasing heart rate & blood pressure, storing fat, increasing appetite, breaking down muscle tissue and suppressing immune function. We can’t always remove the factors that cause stress, but we can control how we respond to these triggers. It’s commonly known that exercise increases our endorphins. Endorphins are released from the pituitary gland and are commonly known as that ‘rush’ of energy and satisfaction post exercise. The effect of endorphins can counteract the effects of cortisol, by decreasing appetite, and reducing tension & anxiety. Endorphins also interact with the receptors in our brain that control our perception of pain, which is why exercise is known to improve our moods. Making time for exercise in the morning, means we feel these benefits throughout the day, when we need them most.
Morning exercises are also at a greater advantage as testosterone levels are typically higher in the morning than they are in the evening. Testosterone is essential for optimal bone health, as well as being responsible for muscle growth and health. Exercising in the morning means you are using this natural fluctuation of testosterone to your advantage.
As we move past holidays and summer social events, setting goals for the year ahead becomes more crucial. We are often setting intentions to improve our physical and mental health, without the proper commitment or motivation to ensure these goals are met. Making time for a morning workout means you are setting aside time at the start of your day, ensuring that the rest of your day is free for other responsibilities. With any goal, consistency is key. Why not set yourself a new goal for the year, and see why the early birds really do get the worm!
The shoulder joint is a complex ball and socket joint that allows 180 degrees of movement. Shoulder impingement occurs when the rotator cuff tendons or bursa (a fluid filled sack) are repetitively compressed in the subacromial space (see image below).
This compression can cause localised inflammation and results in painful movements of the shoulder. It is one of the most common conditions we see in the clinic, especially coming into tennis and cricket season.
The impingement can be “primary” resulting from a structural narrowing of the space or “secondary” due to poor biomechanics and movement patterns of the shoulder. Some of us are born with smaller subacromial spaces or develop bony spurs over time. Secondary impingement can be a result of impaired scapula control, poor posture, or increased mobility in the shoulder joint (Holmgren et al, 2012).
Patients with subacromial impingement may experience pain when sleeping on the effected side, weakness when reaching and lifting and/or an ache referring from the shoulder down the outside of the arm.
Shoulder impingement is classified as a symptom, with many causative factors, rather than a diagnosis (Kibler et al, 2013). It is essential that your physiotherapist acknowledges the concepts of mechanical, movement-related impingement which may in hand prevent the potential for inappropriate surgical interventions (Braman et al, 2014).
The scapula is controlled by a pulley system comprised of muscles attaching to the spine, thorax and arm. Optimal shoulder posture, movement, stability and muscular control are heavily dependent on scapula performance (Kibler et al, 2013). Each muscle has a specific role in helping to tilt and rotate the shoulder blade to allow movements of the arm. The 2013 scapula summit defined altered scapula movement and position as “scapula dyskinesis”. If taping or gentle manual assistance to correct your scapula dyskinesis relieves your shoulder pain this is a fabulous indicator that you are an ideal candidate for rehabilitation and can avoid going under the knife.
As discussed, impingement is caused by a myriad of factors. Traditional treatment involved corticosteroid injections and surgical subacromial decompressions.
Recent evidence has found that exercise management for subacromial impingement is as effective as surgery at 1, 2, 4 and 5 year follow ups (Haahr et al. 2005, Haahr & Andersen (2006), Ketola et al. 2009 and Ketola et al. 2013). This is an exciting revelation in shoulder treatment, showing that a specific exercise program focusing on scapula muscle control, is effective in reducing shoulder pain and improving shoulder function (Holmgren et al, 2012). Exercise management has reduced the need for sub-acromial impingement surgery by up to 80% (Holmgren et al, 2012).
If you are experiencing shoulder pain we recommend you seek a thorough assessment to determine whether your injury will respond to a specific, personalised exercise program to avoid the need for surgical intervention.
Braman, J.P., Zhau, K.D., Lawrence, R.L., Harrison, A. K., & Ludewig, P. M. (2014). Shoulder impingement revisited: evidence of diagnostic understanding in orthopaedic surgery and physical therapy. Medical & biological engineering & computing, 52(3), 211 – 219.
Haahr, J.P., Ostergaard, S., Dalsgaard, J., Norup, K., Frost, P., Lausen, S., Holm, E.A., & Anderson, J.H. (2005). Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up. Ann Rheum Dis, 64(5), 760 – 764.
Haahr, J.P., Andersen, J.H. (2006). Exercise may be as efficient as subacromial decompression in patients with subacromial stage II impingement: 4 –8- years’ follow-up in a prospective, randomized study. Scand J Rheumato, 35(3), 224-8.
Holmgren, T., Hallgren, H.B., Oberg, B., Adolfsson, L. (2012). Effect of specific exercise strategy on need for surgery in patients with subacromial impingement syndrome: randomised controlled study. British Journal of sports medicine, bjsports-2012.
Ketola, S., Lehtinen, J., Arnala, I., Nissinan, M., Westenius, H., … & Rousi, T. (2009). Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br, 91(10), 1326-34.
Ketola, S., Lehtinen, J., Rousi, T., Nissinen, M., Huhtala, H., Konttinen, Y. T., & Arnala, I. (2013). No evidence of long-term benefits of arthroscopic acromioplasty in the treatment of shoulder impingement syndrome. Bone and Joint Research, 2(7),132-139.
Kibler, W. B., Sciascia, A.D., Bak, K., Ebaugh, D., Ludewig, P., Kuhn, J., … & Cote, M. (2013). Clinical implications of scapula dyskinesis in shoulder injury: the 2013 consensus statement from the ‘scapular summit’ report of 2013. British Journal of sports medicine, bjsports-2013.
There is a large amount of evidence surrounding the importance of gluteal strength as a protective factor for many musculoskeletal conditions.
A significant weakness in hip abduction (movement out to the side), extension (movement backwards) and external rotation (movement turning out away from the body), with associated hip adduction and internal rotation during functional tasks has been identified in people with patellofemoral pain compared to pain free individuals (Selkowitz et al., 2013).
In other words, people with anterior knee pain were found to have weaker gluteal muscles compared to people without any pain.
Abnormal hip mechanics has also been linked with Iliotibial Band Syndrome (ITBS). As the gluteus medius muscle is the prime hip abductor, weakness in this muscle can lead to greater angles of hip adduction therefore potentially increasing the strain placed on the ITB. It was found that runners with ITBS had greater deficits in gluteal muscle strength on the side of the affected limb, compared to the unaffected limb (Fredericson et al., 2000; Niemuth et al., 2005).
Additionally, poor neuromuscular control of the lower limb, in particular excessive dynamic valgus (knee dropping inwards when landing) is one of the primary risk factors for ACL rupture (Hewett, Myer & Ford, 2005). What causes your knee to drop in during landing you ask? The simple answer, weakness in your gluteal muscles.
Due to this apparent association between gluteal muscle weakness or dysfunction and lower extremity injury, there has been an increased focus on gluteal strengthening as part of injury rehabilitation or prevention programs prescribed by Physiotherapists.
As a practitioner prescribing exercises, it is important that we choose the most effective three to five exercises on an individual needs approach. Generally speaking, when doing gluteal strengthening exercises it is not uncommon to experience overactivity of the Tensor Facia Lata (TFL) muscle. The TFL works similar to the middle fibres of the gluteus medius and upper fibres of the gluteus maximum in that they all abduct the hip (movement out to the side). However, the TFL also acts to internally rotate the hip (rotates it inwards) which can exert forces onto the outside of the knee leading to conditions such as patella femoral pain. Due to this it is important we choose exercises that optimise gluteal activation whilst minimising TFL activation.
Selkowitz and colleagues in 2013 used fine wire electode EMG on the TFL and gluteal muscles to measure muscle activation during various commonly used gluteal strengthening exercises.
The clam , crab walk (or side step) , four-point kneeling hip extension with a straight knee , four-point kneeling hip extensions with a bent knee , bilateral bridge , and squat  all showed statistically significant higher gluteal muscle activation than the TFL. The gluteus medius was preferentially recruited during the side-lying hip abduction  and hip hitching , and the superior fibres of gluteus maximus was recruited best during the clam  and unilateral bridge 
If the goal is to preferentially activate the gluteal muscles whilst minimising TFL activation these nine exercises can now be prescribed with confidence, on an individual needs basis.
Fredericson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann, S. A. (2000). Hip abductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sport Medicine, 10(3), 169-175.
Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., ... & Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes a prospective study. The American journal of sports medicine, 33(4), 492-501.
Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sport Medicine, 15(1), 14-21.
Selkowitz, D. M., Beneck, G. J., & Powers, C. M. (2013). Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. journal of orthopaedic & sports physical therapy, 43(2), 54-64.
You may be familiar with the term ‘Fascia’ in relation to a common injury known as ‘Plantar Fasciitis’. However what some people may not know, is that fascia is not only located in the foot but rather, right throughout the body.
Fascia is a strong connective tissue that serves many purposes, mainly compartmentalizing and connecting your muscles forming a body-wide tensional network of fascial continuity (Wilke, J). As with other structures within the body; for example soft tissue, joints and ligaments, fascia can also impact your body and be a source of pain.
For example, lower back pain is a very common complaint that we see every day at CSSM. Injury and subsequent immobility in the area can lead to decreased movement of the thoracolumbar fascia (a term given to the broad, thick diamond-shaped fascia spanning the middle and lower back regions). If this is a chronic problem, adhesions within the fascia can develop leading to long-term issues in the area, meaning that your back may feel ‘stiff and tight’ and therefore be influencing your pain.
Over many years, many physical therapists have started to incorporate assessment and treatment of fascia leading to positive results in terms of symptomatic relief, and injury prevention. You will also be interested to note that some of these techniques can be utilised on a daily basis at home using a foam roller!
A recent study has showed a positive relationship between using the foam roller on the thoracolumbar fascia (Griefahn A, et al). You may be more familiar with the techniques used on your upper back by lying on the roller vertically (along your spine as well) and horizontally, using your legs to push your body back and forth. This in turn will not only help to increase movement in the joints locally, but also reduce tension in the thoracolumbar fascia, therefore having a positive effect throughout the spine.
These treatment principles can also be applied throughout the body with other common conditions such as ‘runner’s knee’, jaw/TMJ pain and more. If you have any questions regarding fascia then do not hesitate to ask your treating practitioner.
Wilke J. 2016, Myofascial Chains Revisited: A Review of Several Suggested Force Transmission Lines from an Evidence-Oriented Perspective with Special Focus on Low Back Stability.
Griefahn A, et Al. 2016, Do Exercises with the Foam Roller have a short impact on the Thoracolumbar Fascia? – A randomized controlled trial
The TGA (Therapeutic Goods Administrator), Australia’s drug regulator has issued a warning to women about the use of anti-inflammatories during pregnancy.
Whilst pregnant women should always speak to their health professional before taking any medication, many women consider anti-inflammatories “harmless” like other drugs such as paracetamol. Anti-inflammatories are marketed as a common remedy for headaches, period pain and other general pains; and many women may take them before they are even aware that they might be pregnant.
Taking anti-inflammatories during early pregnancy has been linked with increased risk of miscarriage.
The TGA is warning all women thinking of conceiving to avoid these popular drugs including Voltaren, Naprosyn and Nurofen; and are in discussion with drug companies to make sure they display obvious warnings on the packaging. The TGA has stated “The data suggests that the risk is greatest when the medicine is taken close to the time of conception."
American researchers interviewed more than 1000 recently pregnant women and found that use of NSAIDs increased the risk of miscarriage by 80 per cent.
There are many studies relating to the use of non-steroidal anti-inflammtory drugs (NSAID) during pregnancy. Antonucci et al outline “Increased risks of miscarriage and malformations are associated with NSAID use in early pregnancy. Conversely, exposure to NSAIDs after 30 weeks' gestation is associated with an increased risk of premature closure of the fetal ductus arteriosus” (part of the developing heart). “Fetal and neonatal adverse effects affecting the brain, kidney, lung, skeleton, gastrointestinal tract and cardiovascular system have also been reported after prenatal exposure to NSAIDs.”
A study by Wiley et al identified “Many pregnant women get prescriptions for NSAIDs during their first trimester, and even more--up to 15 percent--take over-the-counter versions of these drugs.”
The current advice from the TGA is “If you are pregnant, think you may be pregnant or are trying to become pregnant, consult a health professional before using these products and consider using an alternative medicine.”
“TGA pregnancy warning for popular over-the-counter painkillers” The Age Newspaper. October 11, 2016.
Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. NCBI. Antonucci et al. May 2012
First Trimester Use Of NSAIDs Is Associated With Cardiac Abnormalities In Babies. Wiley, John et al. Science Daily. August 25, 2006
Tension headaches are the most common type of headache and affect 36% of men and 42% of women - that's 7 million Australians. Tension headaches usually present with some of the following characteristics:
The causes of tension type headaches are multiple and include different muscular conditions. Excessive muscle contraction such as jaw-clenching and active trigger points or “knots” can induce one. Poor posture, be it at work, in front of the computer or driving, are the other main culprits. Other causes include stress, anxiety and fatigue.
Our myotherapists here at CSSM can help you with a variety of treatments.
Moraska AF, Stenerson L, Butryn N, Krutsch JP, Schmiege SJ, Mann JD. Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial. The Clinical journal of pain. 2015;31(2):159-168.
The excitement is building in the lead up to the 2016 AFL grand final. But we should spare a thought for the players who have been recently injured and will be watching from the sidelines like the rest of us.
Sports injuries can affect a variety of tissues including muscles, ligaments, tendons and bones. Interestingly, it is estimated that greater than 60% of all sports injuries occur to the lower limb.
For our top four AFL teams this year, of the players who are excluded due to injury, 67% are suffering a lower limb injury and 6% have an injury specifically affecting the foot.
Due to the fact that feet carry all our body weight, foot injuries unfortunately can take extended periods to fully heal and returning to sport too soon can be detrimental long term.
Sydney Swans defender Michael Talia has a partial tear to the LisFranc ligament with bone displacement which may take a least three months to heal. Sam Reid also from the Swans has an achilles injury which should be ok in a few weeks.
Marcus Adams from the Western Bulldogs will be in a moon boot for at least two weeks after spraining his midfoot.
A Lisfranc injury sustained by forward Jarrod Pickett from GWS may take up to six months to heal. Jarrod will need surgery and then rehab before returning to full fitness. Midfielder Jack Steele also from GWS has sustained a foot injury during training which has prematurely ended his season.
Cory Gregson from Geelong has a stress fracture in the navicular for which he has had surgery and will take about 10 weeks to heal.
We wish all these players the best for their recovery.
You don't have to be an athlete to suffer a sports injury. At Camberwell Sports and Spinal Medicine we treat all types of sports injuries for both professionals and amateurs. It is estimated that in Australia, one million sports injuries occur each year. It is important to realise that up to 50% are preventable. Prevention can begin with the right advice regarding footwear, technique, training frequency, intensity and duration. Regular check-ups are recommended to alter training appropriately and address injuries when they occur.
Sport injuries can result in time spent off work or school as well as significant medical costs which sometimes involve hospitalisation. Visit CSSM today to book in your running gait assessment to optimise your gait, have your footwear and training regime assessed.
Caroline Finch, leading sports epidemiologist. Injury prevention and the promotion of physical activity: what is the nexus?, Caroline Finch and Neville Owen, Sports injury Prevention Research Unit, School of Health Sciences, Deakin University and Faculty of Health and Behavioural Sciences, University of Wollongong NSW. HAZARD, Edition number 8, Autumn 1991, Victorian Injury Surveillance and Applied Research System (VISAR), p.1
Beginning a new exercise program can be overwhelming. There is so much choice and variety, but not a lot of information about different programs and what works for different bodies.
Crossfit, yoga, spin class, body pump- just to name a few. What’s a fad, and what will actually benefit your body?
How is Pilates different to the rest?
Pilates is a series of controlled, isolated movements that looks to lengthen and strengthen the muscles of the body. Pilates typically focuses on your ‘core’ abdominals. Your core is not just your ‘6 pack’ it’s the muscles that attach to the trunk of the body (your spine and pelvis) and includes abdominals, glutes and erector spinae (back) muscles.
The idea is to strengthen these trunk muscles to improve your posture and mobility so that your limbs move more effectively.
In a gym setting, you would typically work your global muscles (like quadriceps in your legs) or deltoids (in your shoulders). While this is great strength training, in terms of improving posture and spinal mobility, we need to focus on the intrinsic muscles- which is where Pilates is better.
Pilates is also one of the only forms of exercise that compliments other training. For example if you are a runner, you could combine Pilates training to assist with recovery and to strengthen your gluteal (bum) muscles, which will improve your running. This principle can then also be applied to a variety of other sports or activities
In fact, studies have shown that for those who attended two 45 minute Pilates training sessions a week - after 8 weeks their flexibility and lumbo-pelvic stability had improved significantly. (ncbi.nlm.nih.gov Asian J Sports Med 2011)
Pilates exercises are also easily adapted to a variety of levels and capabilities. Pilates can be safely performed pre and post pregnancy and post surgery (clinical Pilates). As well as this, Pilates is supervised by a trained practitioner, meaning you know you are performing each exercise safely - something that lacks in a typical gym setting.
A concern from many clients is that they believe they aren’t flexible and can’t do Pilates. But that is exactly why we come to Pilates, to increase our flexibility and to improve our posture. You don’t need to be flexible or strong to start, you just need to have the desire to improve.
If you have a pre existing injury, we recommend you chat to your practitioner before commencing a Pilates program, because in that instance clinical may be more beneficial to you (clinical is supervised by a physio and is rehabilitation based).
Your first Pilates Fit class is free, you have nothing to lose, and everything to gain!
We’ve all been there – whether it be post-Christmas, post winter, post injury or even post baby – finding the motivation again after a period of time off can be hard. Here’s a few things to help you bounce back into your exercise routine.
Don’t be hard on yourself – Get rid of the guilt, stop setting high expectations that are unrealistic to achieve – this only leads to negativity and punishment. If you have been feeling bad for missing out on exercise, turn it into excitement and confidence about starting again and reaching your goals.
Set a goal and write it down – Going into anything without a plan is a sure way to increase your chances of failing. Have it clear in your mind & put in down on paper. Think about both short and long term goals and make it specific – Eg; how many days do you want to run, what distances/duration you want to achieve and ultimately the long term goal might be completing a fun run on a set date. If it’s written down and in a place you regularly sight it, it will make you accountable for your actions and is often the best form of motivation.
Prepare and set yourself up for success – Plan or allow adequate time for what you want to achieve in your running session or workout. Take note of your progress by ticking or crossing or recording what you have achieved beside your list of goals. Prepare yourself by packing your lunch or gym gear the night before to allow yourself a better night sleep to wake up fresh and lastly if you have good self-control you will spend less time resisting desires against exercise and you are more likely to achieve you goals if everything is prepared.
Start out slow – If you’ve had a break from exercise due to injury or just simply not having the time, it is important to start out slow to reduce the likelihood of re-injury or a new injury from overloading your muscles and joints too quickly. It is also important to allow time to warm up and cool down properly with exercise to best avoid muscle soreness the next day.
Don’t procrastinate and never give up – Whilst it’s easy to procrastinate in life, it is bad for our will power, only making us more stressed as a result. Our willpower can be overused and weakened just like our muscles, but it can also be strengthened by making positive choices. So bite the bullet and stop making excuses, you will feel better for it in the long run.
Try something new – Sometimes routine can become mundane and after a period of time doing the same thing causes a loss of motivation. Stop it in its tracks and make your exercise routine a variety. If it’s running – include some steady runs with some interval/speed or hill running. If you are a gym goer – try exercising outdoors, if you struggle flying solo – try a team sport or recruit a friend to exercise with. Don’t make exercise a chore, for you to be successful at achieving your goals you must enjoy what you are doing.
Reward yourself – Starting anything new is hard, it takes willpower to adopt a change in behaviour, so make sure you reward yourself along the way to further drive your motivation to keep going. It might be little rewards along the way such as a new item of clothing or a massage or even a bigger reward like a holiday once the final goal is achieved.
Remember the important thing is to have a positive outlook on starting a fresh, don’t beat yourself up if you miss a session here or there, recognise you are doing well for having started and keep moving forward. Good luck!
As a physio I prescribe and encourage movement as therapy. I use my hands to mobilise, stretch, massage and move body parts; I use my voice to educate, encourage, plan and prescribe movement strategies; I use my body to demonstrate and visually communicate movement patterns. Movement really is a metaphorical feast for the senses and it’s also highly therapeutic.
Movement therapy………yes I’ve moved on (pardon the pun) from the term exercise. Patients don’t necessarily want to exercise better, they want to MOVE better and FEEL better and PERFORM better. Maybe even HEAL better.
Movement is widely prescribed as a therapy for most disease states of the body - from pain and stiffness in our muscles and joints to diabetes, asthma, heart disease, cancer and autoimmune disease to name a few. So what is it about movement that is so therapeutic across such a wide variety of conditions?
The common link to all disease in the body is chronic, low grade inflammation. It’s the body’s neuro-immune system attempting to restore balance. Our nervous system and immune system working together, releasing inflammatory chemicals like cytokines and hormones like cortisol. Driven by an overactive autonomic nervous system and exacerbated by stress and modern lifestyle choices.
The prescribed antidote to this modern day chronic disease dilemma is movement. Why? Because the physical organ that is our nervous system moves and stretches as WE MOVE. It glides and slides as we bend and flex and extend. Movement obviously keeps the nervous system physically healthy, infusing it with blood and oxygen. But movement is also highly anti-inflammatory, it changes the balance of the chemicals in the neuro-immune system, calming the inflammatory response.
So movement therapy is really immunotherapy. It balances the immune response by balancing the pro and anti-inflammatory chemicals in the nervous system. Ultimately health and well-being.. FEELING well and MOVING well and PERFORMING well…. is all about achieving the right chemical balance in our nervous system by creating a balance between movement and stillness.
And as for the prescription of movement…. well, I’ve moved on from numbers too. 10 reps 3 times a day is arbitrary. It really depends on the chemical balance in your nervous system. If your inflammatory profile is reasonably low then you can move more vigorously, more often. If your inflammatory profile is high then go gently with less repetitions and adopt the ‘little and often’ rule. Skilled therapists are terrific at judging from your history and examination where you sit along the inflammatory spectrum.
Set a goal and start moving. Find the right balance for you. Your immune system will do the rest.
Special Event - Wednesday 7th September 2016 @ 7:15pm
Camberwell Sports & Spinal Medicine welcomes four-time Olympian Craig Mottram to a special evening talk-fest on running - whatever the distance!
As the days start to become longer we find that we are only a few weeks out from the Melbourne Marathon, the traditional start to the Spring/Summer Running Season.
Our Run Long Run Strong evenings are targeted towards runners of every level and ability with a view to educating participants about training injury free, improving performance, and being the best you can be. Previous speakers have included Olympian Jess Trengove and Hawthorn High Performance coach Andrew Russell.
No one has more knowledge about what it takes to toe the line than Craig Mottram who first represented Australia at the Sydney 2000 Olympics. Craig will join the panel with his wife Krystine (a psychologist) alongside members of CSSM's expert team to bring you an entertaining and informative evening. Providing advice on training and preparation, injury prevention, injury management, strength and conditioning, and more.
Spaces are limited to only 50 guests for this event. Our previous Run Strong events have sold out very quickly so we encourage you to purchase your tickets as soon as possible. Tickets can be purchased for $20 with 100% of proceeds of the evening going to CSSM's preferred charity, The Indigenous Marathon Foundation.
Ten Tips for the Ski Season
The snowflakes are falling and soon Melbourne will be migrating to the mountains for weekends of skiing and tobogganing!
Here are my top ten tips to ensure you make the most of your ski trip and be as prepared as possible.
Check your equipment well before you depart for your trip. Consider buying new equipment as newer light weight equipment will have more bounce in it and make your skiing much more enjoyable. Try on your boots and make sure they fit correctly, wear them around before your holiday to make sure they are comfortable.
Increase your base fitness level and you will be able to make the most of your costly lift pass. Cardio respiratory fitness is essential for skiing so try something like cycling as a great work out that won’t over load your knees. Furthermore, do a ski fitness program to target specific muscle groups you require for skiing (see tip #10).
Rest is the most underrated performance enhancer. Whilst it is essential to strengthen in preparation for skiing it is just as important to provide the body with rest and stretching. Focus on stretching quadriceps, glutes and hip flexors to maximise your flexibility and muscle function.
4. Chill (Pardon the pun)
Take it easy! Start slowly and build the intensity and difficulty of your runs. Train yourself on the groomers to get use to your skis and boots and slowly progress. It’s easy to arrive at the mountain all amped up but try to save yourself from burning out on day one.
Take a lesson. Yes, they are expensive but at the same time a half day of expert tips doesn’t go astray whether you’re a novice or experienced. An instructor will help you make the most of your new equipment, give you specific skills to work on and provide advice on the best runs for you.
Just like a netballer practices throwing drills and a swimmer practices high elbows – a skier should perform drills to improve technique. It is recommended that you find a gentle run and practice long radius and short radius turning as well as identifying your centre of balance by leaning too far forwards and too far backwards. Once you’ve nailed this try progressing to some steeper runs.
It pays to plan out your goals and what you’d like to achieve by the end of the week. Perhaps, this is something you could discuss with your instructor.
Swap the wine for water; it easy to overdo it on the first night when you’re 10,000 feet higher than normal. Alcohol can exacerbate symptoms of high altitude sickness, including headaches and nausea. Never the less, a celebration at the end of a week well skied is always warranted.
When you’re fatigued and running out of gas, back off. It’s always the skiers who keep hurtling down the black runs that end up calling the rescue toboggan. As a physio, I see tonnes of skiing injuries, from broken wrists to ruptures ACLs. When required, rest and rejuvenate, take a day sitting by the fire and return to skiing when your body is back at its best.
Skiing is a fantastic workout for your body as it requires the use of all muscles. Here are some specific muscles to target and strengthen in the lead up to your trip:
Quadriceps: the most vital muscles required for skiing are your quads. These muscles hold you in position and help you steer and stop. Fabulous exercises for your quads are squats and lunges.
Hamstrings and Glutes: As you are skiing downhill you typically will hold your trunk in a flexed position, this requires strong eccentric (contraction on length) strength from your hamstrings and glutes. Good exercises for this are; bridges, single legged dead lifts and step ups.
Inner and Outer thighs: Your outer thighs help keep your body stable and enable you to steer whilst your inner thighs work like crazy to keep your skis together. Work these muscles with side lunges, side leg lifts, inner thigh squeezes and side leg squats.
Calves: Because your knees are bent as you ski, your calves (in particular your soleus) help you stay up right so you don’t fall over. Strengthen your calves by performing calf raises off the edge of a step.
Abs and Back: To maintain a forward flexed position through your trunk whilst skiing your abs and back must have great endurance. It is essential to strengthen these muscles in order to protect your spine. Work these muscles with exercises like toe taps, planks, back extensions and dumbbell rows.
Arms: Arms help push off with your skis and balance you. Make sure you work your biceps and triceps along with the rest of your body.
These days it seems there are a lot of trends in the fitness industry. Spin classes, Yoga, Crossfit, Pilates. It can all be a little overwhelming. But it can also be difficult to know what is going to benefit your health, and what is just a fad.
Pilates has always been the go-to exercise choice for physiotherapists and health-care practitioners alike. It is safe, challenging and an enjoyable way to restore strength and alignment through the body. It is also one of few exercise programs that can be easily applied to a variety of ages and abilities. But did you know there are different kinds of Pilates?
If you have been to the clinic before, no doubt you would have seen or experienced the clinical Pilates program. Designed for its rehabilitative purposes, clinical Pilates is personalised and tailored to an individual, depending on their specific needs and the nature of their injury. You would generally consult with your physiotherapist before commencing, and would then undertake a 4-5 week program depending on your goals and the severity of your ailment.
But what happens after clinical Pilates? Or what if you are not injured, or your ailment is not restricting you in day-to-day activities? That is where Dynamic Pilates enters.
Dynamic Pilates is a fitness based program, which looks to strengthen, tone and stretch the muscles of the body. Classes involve both body weight and resistance based exercises, which is highly effective in reducing muscular imbalances and improving general posture. It is the perfect program for those looking to challenge their bodies, without risk of further injury.
Classes are taught using both reformer and mat based exercises. Each class will incorporate exercises designed to strengthen generally weaker muscle groups, such as glutes, and release generally restricted muscle groups, such as hip flexors. Classes are also a fantastic way to cross-train, when combining with another sport or exercise program.
Dynamic Pilates is the perfect compliment to your current exercise schedule. From the athlete to the weekend warrior, and everything in between, Dynamic Pilates can cater to a variety of ages and abilities. If you are looking to improve your strength, flexibility and posture, we have the program for you.
For further information please contact the clinic.
The Perfect Pointe
When is the right time for a ballet dance student to progress to pointe work? Many students wonder at what age they might get their first pair of pointe shoes.
The dancer must first undertake a detailed assessment with a podiatrist or physiotherapist experienced in performing pre-pointe assessments. It is important to determine a dancer’s readiness in order to avoid potential injuries and the development of bad habits.
Dancing en pointe requires significant strength, athleticism and discipline. Beginning too young or when the body is not strong enough can be detrimental in the long term.
The en pointe position places significant pressure on the bones and soft tissues of the foot and ankle, up to ten times the dancers body weight on her toes and feet. Some bones in the feet are still growing until age 16 or even 25 years of age. And damage can occur in the growth plates causing malformed bones if a dancer is not strong enough. Damage can also occur to other joints such as the knees and hips; which may not become apparent until years later.
Many dancers begin pointe work at approximately 12 to 14 years of age; although age alone is not an adequate predictor of growth and maturity. When deciding if a student is ready to begin pointe work the practitioner will consider the number of years and hours per week the dancer undertakes. The practitioner will perform a detailed assessment which includes tests of strength, flexibility, neuromuscular control, balance, alignment and ballet technique. The body as a whole will be evaluated, not just the foot and ankle. The dancer must be able to perform all tests maintaining balance, control and alignment to be considered ready.
It must be recognised that pointe work is the end result of slow and gradual training of the whole body, back, hips, leg and feet in perfect balance and alignment. This will naturally occur at different ages for different dancers and should not be rushed. Practitioners will also expect a good attitude and work ethic which is required to dance at an advanced level.
Podiatrists Gen and Sarah at CSSM enjoy the opportunity to work with dancers; both for undertaking a pre-pointe assessment and in the prevention and management of injuries associated with dance.
Richardson M, Liederbach M, Sandow E. Functional Criteria for Assessing Pointe Readiness. J Dance Med Sci. 2010; 14 (3): 82-88. Weiss et al. When Can I Start Pointe Work? Guidelines for Initiating Pointe Training. Journal of Dance Medicine and Science. 2009; 13(3)). IADMS
Physiotherapists have been trained to treat a variety of conditions. We are commonly known for our expertise in treating musculoskeletal conditions and sports injuries, however we also work in conjunction with other medical professionals to help manage various neurological, cardiovascular and genetic disorders.
Parkinsons Disease Boxing legend Muhammad Ali was perhaps the most well known Parkinsons Disease (PD) patient, but approximately 70,000 Australians are living with Parkinsons (Parkinson’s Australia, 2015). Parkinsonism is characterised by a disorder of movement consisting of tremor, rigidity or increased stiffness in joints, slowness of movement, slowness in initiating movement and freezing while moving (Carr and Shepherd, 2010). The role of physiotherapy in the early stages of PD is promoting physical activity as a means of maintaining an active lifestyle, a flexible neuromusculoskeletal system, cardiorespiratory fitness, muscle strength and balance. In the middle stage of the disease, cueing and cognitive strategies are of greatest importance for optimising the performance of everyday tasks. The appropriate prescription of gait aids is also necessary when moving from the middle to later stages of the disease (Carr and Shepherd, 2010).
Walking The benefits of walking practice have been well established for people with PD (Carr and Shepherd, 2010). The aim of walking practice is to increase the stride length in order to increase overall walking speed, as opposed to increasing the cadence (amount of steps). In the early to middle stages of PD, moderate to high intensity walking may also have positive effects on maintaining muscle length and cardiovascular fitness. Given that in PD walking speed and stride length is most greatly affected under more complex walking conditions, incorporating backwards walking, dual tasking and negotiating obstacles is recommended.
Treadmill walking has been found to have an immediate effect of promoting a walking consistency significantly greater than that for normal overground walking (Frenkel-Toledo et al 2005; Bello et al 2008). Upon the completion of a treadmill-walking programme, several studies have found people with PD have gained the ability to walk faster and further (Miyai et al 2000, 2002; Cakit et al 2007).
Balance Training to improve balance involves methods that safely challenge a persons ability to make postural adjustments. Since impairment of reactive postural adjustments is a problem for people with PD, specific training is recommended in order to decrease the occurrence of falls. This type of training is however difficult to do at home without the supervision of physiotherapists due to safety concerns.:paragraph!Standing up and sitting down People with PD are slow to stand up from sitting. Physiotherapists help people with PD use cognitive strategies and cues to train a more effective motor pattern. Improvements in time to stand up, peak horizontal and vertical speeds have been found in PD patients who participate in motor skill therapy with cueing (Mak & Hui-Chan 2008).
http://www.parkinsons.org.au/what-is-parkinsons Bello, O., Sanchez, J. A., & Fernandez‐del‐Olmo, M. (2008). Treadmill walking in Parkinsons disease patients: adaptation and generalization effect. Movement Disorders, 23(9), 1243-1249. Carr, J. H. (2010). Neurological Rehabilitation, Optimizing motor performance. Elsevier India. Cakit, B. D., Saracoglu, M., Genc, H., Erdem, H. R., & Inan, L. (2007). The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinsons disease. Clinical Rehabilitation, 21(8), 698-705. Frenkel‐Toledo, S., Giladi, N., Peretz, C., Herman, T., Gruendlinger, L., & Hausdorff, J. M. (2005). Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinsons disease. Movement Disorders, 20(9), 1109-1114. Mak, M. K., & Hui‐Chan, C. W. (2008). Cued task‐specific training is better than exercise in improving sit‐to‐stand in patients with Parkinsons disease: A randomized controlled trial. Movement Disorders, 23(4), 501-509. Miyai, I., Fujimoto, Y., Ueda, Y., Yamamoto, H., Nozaki, S., Saito, T., & Kang, J. (2000). Treadmill training with body weight support: its effect on Parkinsons disease. Archives of physical medicine and rehabilitation, 81(7), 849-852. Miyai, I., Fujimoto, Y., Yamamoto, H., Ueda, Y., Saito, T., Nozaki, S., & Kang, J. (2002). Long-term effect of body weight–supported treadmill training in Parkinsons disease: A randomized controlled trial. Archives of physical medicine and rehabilitation, 83(10), 1370-1373.
Not all active people can be described as FIT. It has different meanings for individual athletes in the context of their fitness goals and chosen sport.
Take the thin, low body weight of the FIT marathon runner vs the muscly, strong yet FIT sprinter. Both are classed as FIT in their own sports.
Athletes and recreational gym goers are incorporating the latest craze into their exercise regime. High Intensity Interval Training.
High Intensity Interval Training involves very intense bursts of exercise incorporated with low intensity exercise. Training of this nature allows you to exercise at high intensities for a much longer period of time than a steady state, ultimately helping you burn more fat.
Associated Benefits of Metabolic Interval Training
Delayed ageing (and in many cases, rewinding the body clock)
Reduced risk of illness
On the other hand, long distance runners body types adapt to running greater distances over time and inevitably lose weight on the scales, but this is often both fat and muscle.
Losing muscle can result in:
It must be made clear, any exercise that gets people moving is better than sitting on the couch. However, the latest research shows integrating a combination of both aerobic (endurance) and anaerobic exercise (interval training) results in the best outcome for both fitness and health.
I recommend a balanced approach to training for my clients to keep things fresh and interesting to suit your fitness goals.
Laursen and Jenkins, 2002
Summary of HIIT training methods
Training until muscle fatigue to stimulate new muscle growth
Short concise training 45 minutes or less
Training each group of muscles for no more than once a week and allow rest periods for the muscles to grow
Each repetition should demonstrate correct technique and control. For example, not using momentum to complete the exercise.
Complete exercises at a slow pace to ensure the greatest number of muscle fibres are being recruited during a muscular contraction.
Recovery period differs from person to person. If you do not see results, it is possible that you have overtrained the muscle group.
A high quality nutrition regime is as important as a high quality training program.
Herodek et al., 2014
If you have just started a new exercise routine or you are in full swing of training for a marathon - both require good physical and mental health. If you get struck down with a cold or you are returning from a significant illness, its important to listen to your body.
There is a difference between exercising through a runny nose and sore throat and trying to exercise when you are sick in bed with a fever and significant lethargy. Our bodies generally give us a good indication of when they can function normally and when they cannot. When we are healthy our bodies are designed to cope with the stress of a hard training session, making us fitter and stronger. When we are sick, our immune system is lowered and will not cope with the stress of what may be your normal training session.
This is where we all need to pay attention, exercising with more severe symptoms such as a fever, body aches or nausea will increase your body temperature and in turn make you sicker for longer if you try to push through it. If you miss a few sessions it is important to remind yourself that all the flu needs is rest.
If your symptoms are less severe such as a runny nose, you may still be able to exercise but a different form might suit you better such as walking, a bike ride for fresh air or yoga. This will help you feel active and will allow you to maintain some form of fitness but it wont stress your body with the high demands you normally put your body under with a 2 hour training run.
Exercising is a way to boost your immune system, therefore if you exercise regularly you shouldnt be sick very often, but if you are, its a sign to rest.
Pushing your body too hard can result in more significant illnesses such as glandular fever and chronic fatigue which leaves you more than likely unable to participate in your goal of a marathon or whatever you have been training for. If you are training well you should have begun training early enough that if you do need a week or a few sessions to rest it wont be detrimental to your overall performance.
Here are some signs both physical and mental that may lead to a plateau in your performance:
-You are physically exhausted - lacking sleep or poor nutrition.
-You spend hours doing cardio and hate it - your heart rate is not getting high enough to achieve results.
-You are stressed - more so than normal. In this case, exercise can be an added stress.
-Your muscles are over-sore. You are not allowing adequate rest days.
-You are burnt out - there needs to be a balance to ensure you are able to maintain your routine.
-All in all listen to your body - it usually gives us an honest account of how it feels. Look after your body - you only get one!
Introducing PilatesFIT, Camberwell Sports & Spinal Medicine’s Dynamic Pilates program. Read to the bottom to find out about our special introductory offer.
Like traditional Pilates, Dynamic Pilates aims to increase the body’s strength and flexibility through a series of controlled and specific movements. Both classes will typically focus on exercises to improve postural awareness, balance and muscle control. Dynamic Pilates however, uses a principle known as ‘Isolate, Fatigue, Stretch’ which combines the traditional, with a circuit based program that reaps all the benefits of classic Pilates, as well as improving cardiovascular conditioning. You can think of Dynamic Pilates as being like your usual class with an extra kick!
Dynamic Pilates classes cater for beginner to advanced levels, with all classes providing thorough support and guidance from your instructor. With a maximum of 8 per session, there is strong attention to detail, and you can be sure you are performing each exercise safely and correctly. Currently we have Level 1 classes to cater for beginners and those returning to exercise. For the more advanced, we have Level 2 classes which involves a higher level of intensity.
Classes will be conducted by experienced Pilates Practitioners Danielle Thomas and Kim Van Hoorn. Currently the following timetable is available.
Dynamic Pilates Timetable
Level 1 : Beginner
Friday 7am, 10:30 am
Level 2: Intermediate
Thursday 6am, 9:10am
Friday 6am, 2pm
Sign up to class can be done online via the website, and sessions can be purchased in single or bulk packs of up to 10 sessions at a time. :!paragraph
The availability of sessions will grow, with sessions to be run at various times throughout the week, including early mornings, later evenings, and weekends.
Further information can be found on our website.
SPECIAL INTRODUCTORY OFFER –
We are excited about the introduction of our PilatesFIT sessions and want you to try it. To get you motivated we are running an introductory offer of your first 5 sessions for $50.
Regular pricing will be $250 for 10 sessions or $35 for a single sessions.
We are sure you have lots of questions like “How is this different to my regular Pilates?” To get the answers to these questions and more. Download our FAQ page.
In recent weeks, joint manipulation or in lay terms ‘cracking’ or “popping” the spine, has been the topic of much discussion in the media. It is a technique common to Osteopathy, Physiotherapy and Chiropractic but has attracted somewhat negative attention across all professions who use the technique. Today I will discuss why, as Osteopaths, we may use the technique during our treatments and give you all the information you need to make an informed decision as to whether it may suit you at your next visit.
High Velocity Low Amplitude (HVLA), typically known as joint manipulation, is commonly applied during Osteopathic treatment. It is a specific technique which aims to achieve an increase in range of motion and a reduction in pain in a given area, typically in the spine. Rather than achieving movement at all joints in the area, your practitioner will adjust the technique in order to positively impact the joints with the primary issue. Rather than the notion of ‘getting cracked from head to toe’ or ‘getting cracked back into alignment’ it is a technique ideally applied as locally and to as few spinal segments as possible . Further, it is one of many techniques employed by Osteopaths to treat your injury or pain, and subsequently will never be used in isolation during your appointment.
The audible cavitation or ‘crack’ that you may hear is not your bones breaking or grinding together. Studies have hypothesised that it is due to the release of a gas bubble from the joint capsule when the ‘thrust’ is applied. Although this noise can be loud, it is not of concern.
Symptomatic relief following joint manipulation will vary from patient to patient. Generally an immediate sense of more movement is expected. Some temporary side effects may include local pain/discomfort, stiffness, dizziness or light headedness, and are likely to subside within 24 hours of treatment. This can also be as a result of the treatment itself rather than the manipulation in isolation.
Most people do not experience significant adverse events following HVLA. The risk despite being very minimal is important to note when making your decision. The incidence of a significant vascular incident (stroke) was found to be 1 in 2,000,000 with joint manipulation (Terrett, A.G, 2001). Comparatively, when taking the oral contraceptive pill the risk of stroke is 83 times higher (Gillium et al, 2000) than joint manipulation, and taking anti-inflammatory medications increases that risk to a substantial 1,666 times higher (Tramer et al, 2000).
With these figures in mind, while it puts it into perspective, your Osteopath will always ensure that the technique is safe for you. At each appointment a thorough clinical history and assessment will be completed. This will govern as to whether joint manipulation is an appropriate technique for you or your presentation as manipulation is appropriate in many but not all situations or injuries. It is also important to note that your practitioner has undertaken 5 years of study at a university level, and is highly trained to identify when you are not able to receive this technique.
In light of recent debate querying the application of spinal manipulation in the general population, patients can be assured that it is the policy of Osteopaths at Camberwell Sports and Spinal Medicine to never use spinal manipulation on children or infants.
If you have any further questions, your Osteopath will be happy to answer them for you at your next visit.
Stoke incidence following spinal manipulation is 1 in 2,000,000 Terret AG. Current Concepts In Vertebrobasilar Complications following Spinal Manipulation. Des Moines, Iowa: National Chiropractic Mutual Insurance Company, 2001.
Stroke related to birth control pill is 1 in 24,000 (83 times higher) Gillium LA, Mamidipudi AK, Johnston, SC. Ischemic Stroke Risk with Oral Contraceptives, a Meta-analysis. Journal of the American medical Association 2000; (84)1
Stroke related to use of NSAIDs (aspirin, ibuprofen) is 1 in 1,200 (1,666 times higher) Tramer MR, Moore RA, Reynolds JAM, McQuay HJ. Quantitative Estimation of Rare Adverse Events Which Follow a Biological Progression: A New Model Applied to Chornic NSAIDs Use. Pain 2000; 85: 169-182
Posted 25th May 2016
With Mother's Day just around the corner we thought it timely to discuss the Australian Governments Girls make your move campaign. Whilst this campaign is targeted at girls aged between 15-18 years, the significance of improving levels of physical activity for all women is highlighted. Promoting well-being and health for our next generation of mums.
Women face a unique set of barriers to participating in physical activity when compared to men. These barriers are particularly highlighted in young women who can feel they're not fit enough to participate, they may be anxious about not looking the part, they may perceive themselves as not 'attractive enough' to exercise and they often exhibit anxiety about being ridiculed when exercising.
There are a multitude of mental-health benefits related to regular exercise including improving mood and self-esteem, reducing levels of stress and anxiety, socialisation and then of course there are the physical benefits and the long term health benefits such as reducing the risk of some chronic diseases.
The stats in Australia suggest that 9 in ten young people just don't move enough. Younger women are generally less active than their male counterparts, exercise less intensely and are more likely to be sedentary than young males. With the Australian guidelines for young adults set at 1hour of moderate to vigorous exercise per day, what can mums do to get their young daughters moving?
Research suggests that finding an activity that a young women enjoys is one of the key factors to keeping her active. Not into netball? Why not try an 80's dance class! Exercise should be fun and exercising with peers has been identified as an important factor for regular participation. Why not start a sports team with friends? Or take a group of friends to the gym. Family role modelling can have also have a really positive effect on young women. Setting a good example and participating in physical activity will likely have a positive effect on your children's attitude towards physical activity.
So this May in honour of mother's day, women everywhere set yourself a goal to get out, have fun and get moving.
Australia's Physical Activity and Sedentary Behaviour Guidelines for Young People (13-17 years), Commonwealth of Australia 2014 Bauman A, Bellow B, Vita P, Brown W, Owen N 2002. Getting Australia Active: towards better practice for the promotion of physical activity, National Public Health Partnership, Melbourne, Australia in ABS Australian Health Survey; Physical Activity, 2011-12 Van Bueren D, Elliott S, Farnam C 2016. 2016 Physical activity and sport participation campaign insight's report. Department of Health, Commonwealth of Australia.
Osteopathy Awareness Week Caroline Sanguinetti
Did you know?? 1 in 7 Australians have back pain 3.3 million Australians take medication for headaches 28% have arthritis and other musculoskeletal conditions
Over 50,000 Australians see an Osteopath each week. With these statistics in mind, Osteopathy Awareness Week kicks off to a great start in order to get our name out there as one of the leading health services in Australia.
An Osteopath is an Allied Health Professional who specialises in treatment of the musculoskeletal system, as well as taking into consideration the influences of the vascular, nervous and visceral systems.
Underlying principles developed in 1874 focus on the ability of the body to heal itself with the appropriate treatment and management. Such treatment may include soft tissue massage, stretching, muscle energy technique (MET), joint articulation as well as manipulation (HVLA). Using a holistic approach, the aim is to restore the normal functioning of the body as opposed to the injury or problem area in isolation.
Common conditions that we treat include:
Neck and back pain
Carpal Tunnel Syndrome
Our treatment is versatile and tailored to suit our patient, from children to the elderly, pregnant women, and even those suffering from chronic conditions. Osteopaths encourage individuals to proactively manage their injury while preventing future episodes - providing advice on diet, exercise, stress reduction and posture. Long-term this means better health and well-being, as well as less time and money invested in hands on treatment.
According to statistics, Osteopathy is the fastest growing health profession in Australia. From only 300 registered Osteopaths a mere 10 years ago, we currently have 2000 osteopaths practicing.
Currently Osteopathy is offered as a Bachelor of Clinical Sciences and a Masters degree of Osteopathy of 5 years duration in total. With higher intakes each year, we can expect the profession to make consistent improvement in overall awareness in the community, and thus make a large impact in the private health sector.
Despite an increase in overall patient numbers, there is still a degree of misunderstanding of the profession among the public and other health practitioners. While being considered the ‘underdog’ among manual therapy, techniques that are specific to Osteopathy, as well as a ‘combined’ approach is quickly becoming the preferred way to manage and treat aches and pains.
Osteopathy Awareness Week (April 19-25th) aims to voice our principles and beliefs, and promote our profession as a competitive, successful approach to health care.
Oxfam trailwalker is a challenging, life-changing event. This event is a tough physical and mental challenge, but also highly rewarding as it raises money to help fight poverty around the world. During this 100km walk, there are many challenges that you may face, some of which include blisters, chafing, rolled ankles and sore muscles and joints.
Prior to the walk
The number one reason for people not finishing the Oxfam Trailwalk is due to blisters. Prior to the walk, you can ‘prepare’ your feet so they are in optimal condition for the walk. This includes cutting your toe-nails to prevent pressure and bruising, having excess callus removed by a podiatrist and moisturising your feet daily to improve skin elasticity and minimise hardening.
During the walk
It is also important to recognise ‘hot spots’ whilst you are walking. Hot spots are slightly warm or sore patches of skin and are often the beginning of a blister. They are often caused by rubbing or pressure. If you think you notice a hot spot, get it attended to as soon as possible or tape the area with non-allergenic tape (hypafix) to prevent a blister from occurring.
Below are some tips that can help keep your feet happy throughout the walk and prevent blisters. Blisters are caused from an increase in moisture and friction so keeping your feet dry is the best way to avoid the likelihood of blisters.
Shoes: Ensure that you have at least two comfortable pairs of walking shoes or hiking boots. You should have a spare pair to change over every so often to reduce pressure or rubbing on the same spot for the entire 100km. Do not wear brand new shoes during the event as they have not been worn in properly and may rub more than usual.
Socks: Wear high quality moisture-wicking socks that are a wool blend or a synthetic/cotton blend. Do not wear pure cotton or pure wool socks as these hold in moisture and increase your chance of getting blisters! It is also recommended that you change your socks regularly during the walk to provide your feet with some relief.
Tape: Taping your feet with non-allergenic tape (such as hypafix) can help reduce friction when walking. To prevent the edges of the tape rolling when you put your socks on, round the edges of the tape instead of leaving the corners square. There are many different taping techniques that walkers use, so practice taping your feet prior to the event so you know what you like. It is recommended that you cover your feet with hypoallergenic tape where you know they are prone to getting blisters or hot spots.
Moisture control: Some people spray their feet with anti-perspirant deodorant during the event to prevent moisture build-up. Avoid applying Vaseline or pawpaw ointment to the feet as they can actually increase friction between the skin when walking for long periods of time. Socks are a useful tool for controlling moisture.
Come and see one of our friendly Podiatrists in the lead up to the Oxfam Trailwalker for pre-walk taping, footwear advice or any other queries or concerns you may have.
After the walk
Put your feet up and relax, you have just completed 100km so it is well deserved! Try soaking your feet in an Epsom salt bath for relief. It may also feel nice if you roll your feet on a spikey massage ball to release the tension in your feet. If you have any niggles or pains that persist after the walk, ensure to seek professional medical advice from a Podiatrist or another health professional.
The term “LisFranc Injury” has been in the news a lot this week after speculation into the injury of Collingwood Star Dane Swan in the opening round of the AFL season. It was a gruesome injury with many of the initial reports indicating a fractured fibula. Those in the know however, could see that a fractured fibula was potentially the least of Swan’s concerns.
The foot is a complex arrangement of bony arches and supporting ligaments that underpin many of the foot’s functions. Named after a surgeon from Napoleonatic times, a Lisfranc Injury refers to an injury to any of the nine bones or supporting ligaments of the mid foot (fun fact: there are 26 bones in the foot).
These injuries can be purely ligamentous damage, or they can involve bony structures in the foot in a similar manner to the Swan injury. If bony structures are involved, they are classified as fracture-dislocations. Which explains the concern that this injury may be season-ending for Swan. Most often, Lisfranc joint injuries are high energy injuries that occur when a rotational force is placed on a plantarflexed (toes pointing down) foot but other causes can be more subtle.
Diagnosis of a Lisfranc Injury is not always straight forward and often symptom presentation can be delayed. A Lisfranc injury should be considered when there is mid foot pain and difficulty weight bearing after an acute injury or pain when weight bearing through the forefoot when pushing off or performing calf raises in a more chronic presentation.
The management of a LisFranc injury doesn’t always require surgery and depends on the degree of instability present. There are a range of treatment options that can be utilised to treat a Lisfranc joint injury, including footwear advice, strengthening exercises, mobilisation, immobilisation, taping or orthoses can all be options in less severe injuries before considering surgery.
Whatever the cause, a mid foot injury always needs to be thoroughly assessed and managed as a priority. Here at CSSM, we have a strong team that can assess your injury and advise you of the recommended treatment pathway for you. If you think you are suffering from a Lisfranc joint injury please don’t hesitate to book an appointment with one of our friendly practitioners – we can help you!
One of the triggers for foot pain is often a change in activity or a change in footwear as we evolve from our summer beach wear to the winter slog.
Too often at CSSM we see patients who present with long standing foot pain. Invariably this pain starts as a little niggle, which progresses to pain that doesn’t go away and eventually can become quite painful and disabling.
Now we understand when people say, “It didn’t seem too bad so I didn’t bother to get it checked out,” however identifying issues before they become a problem is a key philosophy of CSSM. With this in mind Camberwell Sports & Spinal Medicine is giving you the opportunity to quiz our experts and receive a free foot check. It is time to get those little niggles checked out!
The Free Foot Checks are conducted by our Podiatry team. The assessment involves a half hour session and will include a full biomechanical and video gait analysis. Suitable for children and adults alike, these sessions are focussed on giving the participant a clear understanding of how their foot functions, outlining any evident biomechanical issues, the cause to these problems and suggestions on various management options all with a written report. Designed to answer any questions that you may have, we can also give other specific advice regarding shoe selection and self-management of foot conditions. This will all be provided free of charge with no obligation.
Servicing the general public and athletes from recreational to elite, our podiatrists pride themselves on providing services which have measurable outcomes.
The Free Foot Checks are available until the end of April. Sessions are by appointment only, with only limited spaces available each day. Appointments for Free Foot Checks can only be made by calling the clinic on 9889 1078. Free Foot Check Appointments cannot be made online.
Posted 30th March 2017