Knee osteoarthritis is one of the most common joint diseases and is an expensive burden to health care across the globe. As a result there has been a push over the last 2 years to look at how non surgical management strategies can be improved.
As I discussed in my blog ‘Happy Knees’ (click here to read) an area where non surgical management has failed in the past is by addressing knee OA as a purely mechanical and structural entity and not addressing the complexities of osteoarthritis and the associated biopsychosocial factors.
Programs such as the GLA:D program in Europe and here in Melbourne have shown that incorporating education and general physical activity along side a physiotherapy monitored strengthening program have shown improvements in physical function as well as a reduction in pain medication and sick leave. (1)
At South Coast Physiotherapy we are now able to offer our own knee program specifically for OA knees in line with these findings. It is a 12 week program and is designed to be specific to each individual, incorporating education, strengthening and physical activity. Having the program supervised by a physiotherapist ensures that the intensity and dosage of both strength exercises and physical activity is correct.
The goals of this program are to promote self empowerment to each patient. By the end of the 12 weeks patients will have the knowledge, skills and confidence necessary to manage their knee symptoms and pursue an active life. We will explore how their knee pain is a modifiable symptom driven by sensitized structures rather than damaged structures and is influenced by a variety of biopsychosocial factors.
It is not just people who are already experiencing OA related symptoms that would benefit from this program. Research shows a six fold increase in the likelihood of knee OA following knee injuries with the highest risk found after ACL injury, meniscal tear and intra articular fracture (2). Therefore implementing a knee specific program following a knee injury before any OA symptoms occur would be recommended. The earlier you address knee health the greater longevity you achieve.
Although non surgical options are generally recommended as the first line of treatment ultimately interventions, such as knee replacements, are sometimes inevitable and important for patients to maintain activity and a healthy lifestyle.
If you feel that you would benefit from our knee program then an initial appointment can be booked online or through reception.
1. Skou & Roos GLA:D evidence-based education and supervised neuromuscular exercise delivered by certified physiotherapists nationwide BMC Musculoskeletal Disorders (2017)
2. Snoeker et al Risk of knee osteoarthritis after different types of knee injuries in young adults: a population based cohort study. BJSM
With the easing of COVID restrictions we have increased our face to face appointments with both Brad and James openings up more sessions.
We are maintaining all of our increased sanitisation and social distancing policies and encourage patients, where possible, to wait in their car until their appointment time and to attend the appointment alone unless assistance or chaperone is needed.
As yet we are unable to offer any massage or psychology services but will endeavour to do so as soon as we can.
We would like to take this opportunity to thank you all for your understanding through these unprecedented times.
It is fair to say that COVID-19 has forced changes to both our local and global society that would have been hard to imagine 3 months ago. Our new ‘normal’ seems to be changing on a daily basis.
For South Coast Physiotherapy we are embracing our role as an essential service while at the same time ensuring that we are not putting patients and staff at risk. Last week our Premier, Daniel Andrews, introduced a stage 3 level of restrictions in an attempt to reduce the number of cases and flatten the curve. This means that although we are an essential service we have decided to alter how the clinic will be run through this period to keep in line with these restrictions. Our main focus is to significantly reduce the number of face to face treatments. To achieve this there will only be 1 physiotherapist practising each day who will be seeing only essential or emergency consultations. Therefore if you have been contacted and had your appointment postponed we do apologise and we will work hard to rearranged your appointment once these restrictions are lifted. If you feel your symptoms have deteriorated please do not hesitate to contact the clinic and your physiotherapist will discuss ongoing management over the phone which may well lead to an in rooms appointment being made.
We will also be continuing to utilise our new Telehealth appointments and working on helping patients to transfer onto this symptom as much as possible
There will be ongoing updates about our Telehelth service through our website but please feel free to contact your physiotherapist or reception staff if you would like further information.
South Coast Physiotherapy are now offering a Telehealth service. This is a remote physiotherapy service where we are able to administer a consult through a secure video link. This is perfect if you are in self-isolation or if you are trying to minimise contact during this pandemic. The digital technology that is used with these Telehealth appointments is readily available on the majority of home computers and smart phones. It is safe and effective, and our physios are trained to deliver telehealth consultations.
Telehealth appointments can be booked on-line or through our receptionists.
There will be changes at our clinic this week in line with the current increased Coronavirus precautions. These will be on top of the current recommendations that we have already implemented such as:
Extra precautions starting this week will include:
We would also like to take this opportunity to thank our clients for their understanding during this time and that we will do our best to continue to provide a service whilst working under our professional body’s and the governments recommendations to ensure the safety of yourselves and our staff.
James Gasper, Brad Poyser and Raquel Poyser
South Coast Physiotherapy
Osteoarthritis (OA) is a degenerative process involving the break down of cartilage at a joint leading to pain, swelling and loss of function. The prevalence of knee OA has doubled in the last 50 years and is a major burden on health care services around the world. As a result researchers and health organisations are constantly looking at the best ways to manage this condition. Clinical practice currently suggests that treatments should be directed away from structural/mechanical models which are based on restoring the knee structure and instead should be directed more towards addressing the health of the knee. Understanding that OA is more than just tissue breakdown and that if treatments can control the inflammatory process and tissue sensitivity associated with OA, that there will be an improvement in knee function, pain levels and patient quality of life.
Historically treatments have been structurally and mechanically based, directed towards restoring the lost cartilage either through different types of injections or supplements. However we know that the breakdown of cartilage is not correlated to knee pain and therefore focusing treatment on restoring cartilage will not necessarily make the knee feel or function any better.
Since I qualified as a physiotherapist back in the early 2000s exercise has been one of the first line treatments for the condition with focus on restoring range of motion and improving muscle strength. Studies have shown that it can effectively reduce pain and improve function and when you add this to the extensive list of health benefits that are associated with exercise it is not surprising that it is the first port of call. However even with exercise we need to ensure that it is being directed at improving knee health rather than purely strengthening the knee or replenishing articular structures. Exercise alone is not a sufficient intervention. It needs to be incorporated into addressing knee health and failure to do this is a major reason why prescribed exercise routines sometimes do not work.
The exercise program itself is not the initial priority. When treating a symptomatic OA knee the clinician is not trying to purely restore muscle strength but instead is addressing a complex inflammatory process being driven and influenced by many factors and comorbidities. Addressing these is the first step and once the patient has a good understanding of this and the clinician has an understanding of the goals and beliefs of the patient then a suitable exercise program can be prescribed. As a result the exercises are specific to each patient rather than a generic ‘recipe book’ style program. They can be pilates based, gym based, yoga based, home based, water based or any combination of different exercises, what ever works for the patient and is suitable for their knee and their general health at that point. It is therefore beneficial that when starting a program aimed at helping an OA knee that the individual seeks guidance from a trained health practitioner, such as a Physiotherapist, to ensure that the program fits a ‘knee health model’ rather than purely focusing on structural deficits. Unfortunately in some cases knee replacement surgeries are still required but even post surgery following this model will ensure the best rehabilitation.
We are excited to be providing physiotherapy cover for Coastrek 2019. This is a great annual event where participants trek across some of best coastal areas the Peninsula has to offer while raising thousands of dollars for the Fred Hollows Foundation
To all you Trekkers about to take part in this grueling but equally rewarding event we have listed some tips on managing, and hopefully avoiding, common trekking injuries.
Blisters are always a common complaint for any long distance walk and the key management protocol is to minimize friction and moisture. We would recommend to take a few spare sets of socks and change them regularly, particularly if you have stepped in a puddle or the incoming tide.
We will be providing physiotherapy stations along the course and will be able to do blister taping where necessary.
The best way to reduce risk of soft tissue injuries is completing a full training schedule specific to the tasks you will be undertaking in the lead up to the event. Obviously at this stage all Trekkers will have already completed their training and be fully conditioned and ready for the walk ahead. However no matter how much preparation you have done injuries still occur. What we frequently see at these events is with the excitement and adrenaline of the occasion Trekkers set off at too fast a pace making them vulnerable to blowing up or even injury. So make sure you have a strategy to ensure that you have a set pace and are able to stick to it.
Being a coastal trek the course does include stretches of sand as well some climbs and descents. Knowing at what stage of the trek these harder sections will pop up will reduce the effect they have on your overall rhythm. Trying to maintain a rhythm is important for any endurance event.
Mental fatigue is common in endurance events and whether you are doing the 30km or the 60km trek you are going to be walking for a number of hours. Make sure you stick with your team members, tell jokes, sing songs and help each other get to the finish line.
Finally, remember to enjoy the event, you have all raised masses of money for a brilliant charity.
Any last minute injury fears please contact the clinic and we’ll do our best to get you to the start line.
Good luck Trekkers….
For a long time running has been associated with increased risks of degenerative hip and knee injuries, in particular Osteoarthritis (OA). This association has been so ingrained into public and professional perception that health practitioners have gone as far as advising people to avoid running in a bid to reduce the risks of OA changes.
However these beliefs have been recently questioned when researchers compared a sedentary group of non runners with a group of recreational runners and found that the non runners suffered significantly more OA changes than the running group.
It is important to note that these studies were carried out on healthy subjects with no pre existing knee injuries and also that when they looked into elite runners they found increased risks of OA changes.
As health professionals these findings allow us to reassure patients that they can take advantage of the multiple health benefits of running and have less risk of OA than if they were sitting on the couch.
Even if there are preexisting injuries to the knees we can get people back running with a suitable rehabilitation regime and a gradual return to running program.
With our new running software at South Coast Physiotherapy we are now in the perfect position to offer assessments and programs to get people back running. Give the clinic a call and take advantage of all the benefits that getting back to running can offer.
I have been posting on Instagram recently about choices and accountability and wish to share these thoughts with you as come this time of year we can so easily become just so BUSY and we often put our selves at the bottom of the list.
I used to ask myself why I did this, always rushing around, trying to fit too much in or pleasing everyone else. I now challenge myself to be accountable. I no longer feel guilty about handing dinner over to my partner why I go to the gym. Or block out a busy time on my schedule to sit down to do admin or even just have a hot coffee. I can proudly say I am getting better about making the right choices, for me.
Is it selfish? Maybe. Though I ask, if I don’t make this time in my life for what I value, then is it not giving a little piece of myself away each time? I become obsessed with justifying and burn the candle at both ends. What next, I become tired, anxious and sick? SO I ask, is that not selfish of others to ask I give them so much of me?
I could provide you a number of examples of how we constantly do this to ourselves or I can discuss some ideas on how to reduce the frequency of this happening instead.
You will need a pen, paper and at least 5 minutes…
Being mindful of what choices I make, knowing what values are core and what values are more flexible as mindfully prioritising is essential.
Life is about balance. Progress not perfection. Making choices to ensure this balance and that you are working on progressing towards becoming a better version of yourself.
If you don’t plan on taking 5 minutes to identify your values and to work at aligning these with your choices, think about this …
Will that extra biscuit help you achieve your weight or blood glucose goals? Will staying up for one more episode on Netflix help you tomorrow in that meeting? Will not making lunch the night before so that you have to buy it the next day help you save towards that next holiday? Will not doing my exercises help me reduce my back pain?
If your choices are not helping you, you are choosing pain, choosing broke, choosing fatigue and chaos, choosing chronic disease and you are choosing to come second best.
Now, what do you want to choose, for the best version of you?
My next piece due in Feb, will carry on from this and discuss ways to make sure your 2019 goals not only align with your values, but are also SMART.
For more info on health, lifestyle and behaviour change, on individual or group sessions please visit
www.bebetterhealth.com.au or Call Jen on 0402 751 560
The National Disability Insurnace Scheme (NDIS) offers government support for people with disability, their families and carers.
South Coast Physiotherpy is now fully registered with NDIS allowing us to provide physiotherapy services to those eligible.