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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.

Don’t Let Muscle Cramps Cramp Your Style!

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Is your sporting performance being hindered by regular muscle cramping? You may be wondering why this is occurring and how you can manage and prevent them.

Muscle cramping is a common yet painful and involuntary contraction of a skeletal muscle, which can occur without warning or apparent cause (Bergeron, 2008). Put simply, when there is any disruption at any level within the central or peripheral nervous systems, the muscle fibres (known as the muscle spindles and golgi tendon organ proprioceptors) are affected, which consequently influence the length and tone of the muscle, which can result in the muscle cramp. Typically we see them in the calf muscle, hamstrings or quadriceps.

A study looking at the treatment and management of muscle cramping revealed that there are two distinct categories; skeletal muscle overload and fatigue, as well as exertional heat cramps.

Recovery and prevention of skeletal muscle overload cramps:

As soon as you feel a cramp come on, lower the intensity of exercise. Begin passively stretching and massaging the effected muscle group, provided you can do so within pain limits. You may also find that icing the area will provide some short term relief.

Long term, look at improving conditioning and range of motion through the particular area, as well as individual fitness and stretching programs. Adjustments to biomechanics, equipment set up (e.g. bicycle seat height) and relaxation techniques may also be of benefit. Our practitioners at CSSM are able to assist you with this.

Recovery and prevention of exertional heat cramps:

As these cramps typically occur during or after exertion and generally in conjunction with extensive sweat loss, the cause of this kind of cramping is due to electrolyte imbalance.

First port of call is to promptly replenish the deficit, typically with a high salt solution - which is likely to have an effect within a few minutes. A sports drink will also assist in replenishing electrolyte levels.

Dietary potassium intake is also proven to be beneficial - so think about incorporating yoghurt, salmon, avocado, mushrooms, bananas and dark leafy greens such as spinach into your meals.

If you have any further questions, speak to one of our experienced practitioners at CSSM.

Resources:

Bergeron, M 2008. Muscle Cramps during Exercise is it fatigue or electrolyte deficit?

http://www.healthaliciousness.com/articles/food-sources-of-potassium.php

Jaw, Neck And Head Related Pain

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Do you suffer from chronic headaches and/or neck pain, and struggle to gain long-term symptomatic relief from various treatment modalities? The answer to your pain may lie in the function of your jaw.

The Temporomandibular Joint (TMJ) is a joint located just in front of your ears, which connects your jawbone to your skull. It's used continuously throughout the day when you eat, talk and even breathe. This joint is closely related not only anatomically, but also in its overall function and biomechanics to the upper part of your neck, also known as your cervical spine.

Looking specifically at headaches, a study by Ciancaglini (2001) concluded that there was a distinct association between general headaches as reported by subjects, and symptoms of TMJ disorder. It is therefore vital that overall assessment includes these areas, and subsequent treatment is provided so that the presenting complaint, whether it be the headache or jaw pain, is resolved.

Some symptoms that may indicate a TMJ dysfunction are: pain when chewing or yawning, clicking, tension over the area, inability to fully open your jaw, and in more severe cases, locking. You may also experience ringing in the ears and other auditory problems due to the close proximity with the ear canal.

Currently there is much discussion about the cause of TMJ disorders. Some problems within the joint itself include arthritis, injury, and dislocation of the joint (either from direct trauma, extensive dental work (think wisdom teeth removal!), or general laxity). Bruxism, more commonly referred to as clenching or grinding, can also put significant stress on the area, often occurring when we are stressed, anxious, and even when we are thought to be at our most relaxed - when sleeping. Interestingly enough, it has been found that TMJ related symptoms are more associated with work-related psychosocial factors rather than the actual type of work itself! (Mikko et al, 2003)

Treatment of the neck will be similar to what you may have previously experienced, employing techniques directed at the joints, muscles, fascia and ligaments. Treatment of the jaw itself however is likely to include addressing tight muscles that support and coordinate jaw movement, and correcting any structural or biomechanical compensations present. Be warned - this may involve intra-oral work with a glove! A holistic approach is likely to be taken to also incorporate reduction in stress and anxiety and improvement in breathing technique to prevent reoccurrence if this is in fact the cause of your TMJ pain.

If you feel like you may be experiencing jaw pain, or are suffering from long term chronic headaches, book an appointment with one of the practitioners at CSSM - we can help you.

Resources:

Ciancaglini and Radaelli, 2001. The relationship between headache and symptoms of temporomandibular disorder in the general population

Mikko et al, 2003. Temporomandibular joint related painless symptoms, orofacial pain, neck pain, headache, and psychosocial factors among non-patient

Headache Or Heartache: Is Your Headache Treatable?

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As the days get longer and the weather gets warmer, the hay fever season will inevitably spring (pun intended) into action.

Up to 1 in 4 people in Australia and New Zealand are effected by hay fever, which causes inflammation of the nose and/or eyes (ASCIA). Melbourne, in particular, recorded some of the highest levels of pollen last year and resorted to injecting the London Plane tree (making up 75% of Melbourne’s trees) with hormones in the bid to stop the tree from producing seed pods! Fun fact for the day: Lygon Street was found to be a highly effected area, steer clear!

Now, you might be asking what this has to do with us at CSSM. Studies have shown that hay fever sufferers, as well as other conditions such as upper respiratory tract infections (the common cold), sinus infection and also asthma, can cause a headache. Both migraine and non-migranous type headaches were approximately 1.5 times more likely when suffering from one or a combination of these conditions (Aamodt et al, 2006).

Your osteopath at CSSM is experienced in treating through various structures with the aim to reduce the severity and frequency of these headaches where possible.

When it comes to seeing your Osteopath, we can assist in treating your headache in many ways.

Treating the simplest form of headache, originating from structures within your neck and upper back (Cervicogenic Headache) treatment may involve:

Soft tissue massage, joint mobilisation and stretching to offload structures in cervical and thoracic regions, as well as treating accessory muscles of respiration (Sternocleidomastoid and Scalenes to name a few, for the anatomy gurus out there)

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When there is a sinus or allergy component to your headache treatment may involve:

As above with additional focus through frontal/forehead areas, temples and base of the skull

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When there is a resolving upper respiratory tract infection or other respiratory condition such as asthma contributing to your headache treatment may involve:

As above with additional focus through the ribs, and possible lymphatic/sinus drainage to assist with the recovery process

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If you are experiencing headaches, be sure to see one of our therapists at CSSM – we are here to help you!

References

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ASCIA: The Australasian Society of Clinical Immunology and Allergy.

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Aamodt et al. (2006), Is Headache related to Asthma, Hay Fever and Chronic Bronchitis? The Head-HUNT Study.

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774 ABC Melbourne (October 2014), Hay fever hope: Melbourne tree injections trial aims to reduce allergens.

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Body and Soul Melbourne (October 2014), Hay fever misery prediction: some to get off lightly, others to suffer.

Posted 1st October 2015

All About Osteopathy

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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

Sports injuries

Headaches

Whiplash

Postural problems

Occupational injuries

Carpal Tunnel Syndrome

Tennis Elbow

Arthritis

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.

http://healthtimes.com.au/hub/allied-health/66/news/kk1/rapid-growth-in-osteopathy/769/

http://healthtimes.com.au/hub/allied-health/66/guidance/nc1/what-is-an-osteopath/571/

http://livingsafe.com.au/what-is-an-osteopath-what-do-they-treat/

http://www.osteopathy.org.au/data/Media/Infographics/Osteopathy.jpg

Spinal Manipulation - Help Or Hazard

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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

Focus On Fascia

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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. 

 

References: 

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

When Should I Have An MRI, CT Scan Or Xray?

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Many patients with pain in their lower back are often after treatment and advice on ways to best to manage their condition. Osteopaths and other practitioners are trained in thoroughly assessing and examining someone’s body, and can determine a differential diagnosis that forms the treatment and management plan moving forward. 

Every day we are faced with patients wondering whether they should have some sort of investigation into their pain - x-ray, CT or MRI. In respect to the lower back, MRI can be gold standard for diagnostic value, and will therefore identify problems with the vertebrae, intervertebral discs and soft tissues. However what it is not capable of, is determining the structure that is responsible for YOUR pain. 

Studies in the field of back pain have revealed that imaging cannot reliably diagnose lower back pain, and often cause more false alarm. False alarms, or ‘Red Herrings’, are known as possible structural irregularities that MAY cause someone pain, however are not clinically diagnostic. This may be features of ‘wear and tear’ within the spine, having occurred over many years of an active or even sedentary life. 

While the idea of having an MRI to visualise structures in the back is valuable and extremely tempting, we also must understand the complex outcomes of unnecessary imaging or poor interpretation of results. This can in fact INCREASE patient apprehension and therefore indirectly affect quality of life and lead to a poorer prognosis.  It is important for practitioners in the medical industry to accurately relate the MRI findings to clinical symptoms and manage accordingly with treatment techniques and lifestyle advice (Graves et al, 2012). 

When your pain is not improving over a period of time, not responding to manual therapy, or if you present with any clinical red flag, then imaging is undoubtedly a valuable tool to use. This will change the way that your practitioner manages your condition, and may refer you on for further intervention or assessment as required. 

At CSSM, we encourage patients to discuss their condition with their practitioner. Ensure that you understand YOUR pain, and ways to manage it when conservative treatment is appropriate rather than seeking answers through imaging methods.  

 

Resources:
Graves et al, Early Lumbar MRI not associated with better outcomes, 2012.
Jensen 2010, Early MRI Use, COCA.
https://www.painscience.com/articles/mri-and-x-ray-almost-useless-for-back-pain.php