Physio Blogfrom the team at South Coast Physiotherapy
Sunday, 27 August 2017 09:49
Catastrophizing
How making mountains out of molehills will hinder your rehabilitation We live in a society where we are constantly bombarded with information, be it on the TV, on social media or in old fashioned printed newspapers. News has reached such a saturation point that journalists and news organizations seem to be predicting a global catastrophe at every opportunity in order to get our attention. As well as this exaggeration of negative outcomes being rife in the media it also plays a role in the treatment and management of injuries and illnesses. It is well documented how catastrophizing about pain, function or diagnosis following an injury plays a negative role in rehabilitation. Studies have shown that it leads to worse pain outcomes, increased disability and increased emotional stress. Many of these negative beliefs are a result of real fears and vulnerabilities, which are associated to trying to return previous activity levels. Fear of re-injury and fear of failing to return to a level of function required for a sport or work place, can all create low self-confidence and foster an environment for catastrophizing and even lead to a point where patients can obsess over injuries they may not even have. An example of how this can happen is shown in the table below. Logical thought and reasoning. -> Semi Logical thoughts with increasing fear avoidance. -> Catastrophising and fear avoidance ‘I have a sore back. Maybe I shouldn’t have lifted that table yesterday. I should avoid lifting heavy things for a day or 2.’ ‘I think I need a scan. I could have blown a disc. I had better rest and avoid all lifting.’ ‘The disc could be pressing on a nerve and my back feels unstable. I shouldn’t bend or lift anything.’ ‘My disc has popped out and has compressed…
Sunday, 13 August 2017 10:41
Golf with Ashley Clinch
How do you practice golf? If you have a regular job, with a family your time would be limited. Play on the weekend, practice after work one night a week in winter if you are lucky. Do you go to the range and hit a bucket or 3? Is that helping you improve? Most likely not. Tee it up, hit it, tee it up again, hit it. Ask yourself honestly what would improve your golf game? I know for me at the moment my putting needs to improve to shoot lower scores. I need to make more putts in the 6 to 12 foot range. Tour pros make around 65% of putts from 6 feet and 30% from 10 to 15 feet. So my plan is 3 fold to improve my putting check in with my coach to see that my technique is sound. work on my mindset - yes even a psychologist can improve on this. work on some practice drills on the putting green to help in this range - the Spieth/McCormack gateway drill is a good one i have seen recently. What is your plan for improvement? Contact me to book in for a Performance session.
Monday, 17 April 2017 08:57
Sporting Injuries in the Younger Athlete
Pain in young athletes is a common occurrence, which is often described as growing pains and can be viewed by coaches, teachers and parents as part and parcel in becoming an athlete. With children growing up in a society of sporting heroes who live celebrity lifestyles the attraction of pursuing sporting careers has never been higher and therefore so to is the risk of picking up adolescent injuries. Young Bones A major reason for these injuries is due to the structure of their growing bones compared to the structure of a fully matured adult bone. The articular surfaces and the body of the bone all respond differently to stresses and loads when compared to mature bone. Immature bones also have growth plates that are vulnerable to shear forces and can interfere with the growing process. Added to this is an imbalance between the faster growing muscle and slower growing bone that can create traction forces at muscle attachments. All these factors create injuries that are unique to younger athletes and need to be diagnosed by professionals to ensure that long-term impairments are prevented. Sedentary lifestyle The prevalence of these injuries remains high even though there is good understanding of how they are caused and how to manage them. One of the reasons for this is an increased sedentary lifestyle. Children today are less likely to be walking too and from school, playing in the park or cycling to friend’s houses. Sedentary activities such as playing computer games and watching TV box sets are becoming more and more common. It can certainly be argued therefore that while participation in sports and school activities may have increased this sedentary lifestyle outside sport has lead to the kids of today having spikes in load from sedentary activities to high demand running and jumping…
Wednesday, 14 September 2016 22:23
Running & Arthritic Knees
Arthritic knee pain is very prevalent in the aging population and can lead to a reduction in activity at the very stage of life when we are trying to remain as active as possible. As physiotherapists a lot of our patient management is directed at keeping activities that will aggravate knee pain to a minimum and, at the same time, trying to keep the patient doing their hobbies and sports. Old Wives Tales Some sports and hobbies are more knee friendly than others but it is often not as straight forward as simply branding the ones that involve lots of knee impact as being the most dangerous. The old wives tale stating that too much running will lead to arthritis in the knees does not fit in with current evidence. Current evidence shows that individuals who run and have healthy knees are no more likely to suffer from arthritic changes than individuals who do not run. Runners Vrs Non Runners One study which supported this took knee x-rays of 50 year olds over an 18 year period. The subjects were split into a group that ran and a group that did not .The results showed no increased signs of osteoarthritic changes in the either group. Another study took an MRI of 7 runners before and after a marathon and they found that there were no signs of joint stress or deterioration after the race. Both these studies certainly point towards running not causing damage to the knee. Further investigation into the effect of running on knees in animal studies showed evidence that running may have beneficial effects. A study in 1992 compared a group of dogs that ran to a control group that did not. They found that there was increased cartilage thickness in the groups that ran. Another study…
Monday, 25 July 2016 22:02
Turmeric
Medical and Health care practitioners are advising more and more patients with inflammatory joint issues to take Turmeric as a natural form of pain relief. Although there has been a recent increase in the use of this herb it is not new and has been used for thousands of years in both Chinese and Indian medicine for a wide range of ailments including digestive complaints and chest pains. Turmeric powder is the ground root of the turmeric plant and is what is responsible for the yellow colour in our curries. This yellow pigment is called Curcumin and is thought to be the primary pharmacological agent in Turmeric. Anti-inflammatory properties Curcumin has powerful anti inflammatory properties and its effects have been comparable to Ibuprofen but without the toxic side effects. However the amount of Curcumin in turmeric is low and therefore you would need to take large quantities for the desired effect. Luckily for us in the competitive and profit driven world of pharmaceuticals and natural medicines there are plenty of turmeric powders, tablets and capsules from numerous different companies. There is no definite data or reliable studies at present comparing different brands and anecdotally the message from patients does not seem to point to one brand being better than another. However we do know that Curcumin is not well absorbed when taken orally and it is therefore recommended to take them with black pepper and iperine to aid absorption. Joint Pain The anti inflammatory properties of Turmeric make it a useful and safe way of managing inflammatory joint pain. A recent study found that a Turmeric supplement provided long term improvements in both pain and function in 1000 patients suffering from knee Osteoarthritis (OA). Given the high prevalence of OA in our aging population and the associated problems it brings…
Wednesday, 27 April 2016 22:39
Nordic Walking – Skiing without the Snow…
I have recently been looking into Nordic Walking and its place as a treatment option for patients. This was after a surgeon had specifically recommended it to a patient for her rehabilitation post knee surgery. I have been aware of Nordic Walking for a number of years but have never involved it into rehab programs and therefore thought it would be a good area to look into and see if there is any evidence supporting its beneficial claims. Nordic Walking is a total body version of walking, which has evolved from cross country skiers doing off season training. If you picture cross country skiing with no snow you have a pretty good picture of what it looks like. I first came across Nordic Walking four years ago when a colleague was promoting it to her patients as an exercise that had all the benefits of walking with added upper body engagement. My colleague was a German physiotherapist who had seen the benefits of it back in Europe where it was a popular form of exercise.
Saturday, 13 February 2016 18:41
Management and Treatment - Tennis Elbow
After being glued to the TV most evenings watching the Australian Open I thought a topical discussion for the beginning of 2016 would be the common elbow complaint known as tennis elbow. Now of course we all know that tennis elbow does not always involve tennis and in fact, in reality, tennis players only make up a small proportion of patients with these injuries. Tennis elbow generally presents as pain on the outside of your elbow with gripping and lifting movements. The injury itself is to the tendons of the extensor muscles of the forearm and their attachments at the lateral epicondyle (which is the bony lump on the outside of your elbow). Generally the main muscle involved is the extensor carpi radialis brevis (ECRB). Clinically we call this condition lateral epicondylagia and it is where the tendons (the structure that attaches the muscle to the bone) become worn down through excessive use, a little bit like a rope that has become frayed. This is called a tendinopathy. There can also be situations where the bony attachment also becomes involved which is called an ensthesopathy, but for this discussion we will focus on the tendon. The position of these structures can be seen in the diagram below. This condition is very common, with studies suggesting that 40% of people will experience some form of this injury through their lives. As well as being common these symptoms can take a long time to fully resolve with recent reports indicating it can be a number of years to be totally pain free. It is most commonly experienced in the dominant arm and is a result of repetitive wrist extension. This can be from prolonged typing at a key board, a morning of lifting bricks in the garden or even a poor backhand…
Friday, 04 December 2015 15:53
Hamstring Injury Management & Prevention
We have all seen the classic hamstring injury where the sportsman or sportswoman puts in a sudden burst of speed towards a ball or away from an opposing player only to suddenly grab the back of their thigh with a grimace of pain etched across their face. These injuries are very common in the sporting arena with studies showing hamstring tears being the most common soft tissue injury of all sports injuries. In the AFL they have been found to account for 16% of all injuries and 11% of all injuries in cricket. There is a plethora of research into both the risk factors and the management protocols of hamstring injuries and yet they still fill up the treatment rooms of both professional and amateur sporting teams. Risk Factors As a physiotherapist an important part of our management is to be aware of the risk factors associated with these injuries and minimize them where possible. Areas such as muscle strength, muscle imbalances, ankle mobility, biomechanics and endurance have been shown to have significant roles in hamstring injuries and they are areas that we can control with specific strengthening, conditioning and mobility programmes. Other risk factors such as age, previous injury and the architecture of muscle tissue are out of our control but still need to be taken into account. Assessment When a hamstring injury first comes into the clinic there is pressure on the physio to get the patient back to their sport or back to their workplace as soon as possible. Unfortunately all soft tissue injuries need to be allowed time for the body to heal them and there is generally very little that can be done to speed this process up. Depending on the severity of the tear these time frames can vary, with a low grade tear…
Wednesday, 23 September 2015 16:18
To stretch or not to stretch?
One of the most frequent questions I get asked is in regard to the correct stretching protocol when warming up for sports or at the gym. What type is best? When should they be done and for what duration? Types of Stretches As with many questions regarding the human body, the answer is dependent upon numerous variables and giving a generic stretch protocol is difficult. As physiotherapists we use many different types of stretches including static, dynamic, ballistic, proprioceptive neuromuscular (PNF)and many more. They are generally used to help the body achieve the necessary movement and mobility needed for the task it is trying to perform. Not only do they often form an integral part of a patient’s treatment, but they are also vital in reducing future injury risk. As a result of the flourishing fitness, health and wellbeing industries there is ongoing research into all different types of stretches which is giving us an ever increasing knowledge base into this area. As a result advice on the correct stretching protocol is continually being updated. Variables When deciding what to prescribe for a patient it is important to know what type of activity they are undertaking. For example you would not do the same stretches before you take your first golf swing as you would if you were trying to increase your knee mobility after surgery. On top of this the age of the person doing the stretch needs to be taking into account, as the properties of the structures we are stretching will change with age and therefore will respond differently. These are only a few of the long list of variables that would need to be addressed when giving advice on stretches and it gives an indication how trying to have a generic ‘one size fits all’ stretch…
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Saturday, 22 August 2015 14:53
Skiing injury Prevention
With both Australia and New Zealand having good snow seasons this year and following a recent run of patients suffering snow related injuries I have decided to write this blog on injury prevention when on the slopes. Risk of Injury Although skiing and snow boarding are generally associated, as high injury risk activities recent research looking at the prevalence of these injuries has shown a recent decline. The numbers have reduced from 5 – 8 injuries per 1000 skiers to 2 – 3 per 1000. Research has also shown that the most common injuries in skiing are to the knees which accounts for ⅓ of all injuries and that in snowboarder’s injuries to the wrists are the most common. A study in Japan showed that snowboarders had twice the injury rate of skiers and interestingly a study looking at a terrain park in Canada showed that snowboarders who were listening to music were less likely to have an any injury but more likely to have an injury which resulted in them being taken to the emergency department! When looking at preventing injuries there are obviously areas that we have no control over, which can increase the chances of injury. These can include poor visibility, the quality of the snow and crowded pistes. However there are also many areas that we can control such as wearing protective garments including wrist protectors and helmets. Conditioning One area that has been proven to reduce injuries in skiing is through skiing specific physical conditioning. With snow based disciplines, as with the majority of sports, it is important to be balanced and maintain good alignment and weight distribution through your trunk and lower limbs. However, unlike a lot of other sports, with skiing you are trying to maintain a relatively static position while travelling fast…
Friday, 24 July 2015 11:19
Lateral Hip Pain
Following on from my previous blog about golf injuries, I thought I would look at another common complaint. Lateral hip pain is certainly one of the most common problems we see walk through the door and it is also one of the most frustrating to treat and manage. What is Lateral Hip Pain? Firstly, there are many different structures that could be causing pain through your hip such as osteoarthritic changes, your Sacral Iliac Joint (SIJ) or your lower back so it is important that you have a full assessment in order get the right diagnosis from the start. The condition I am going to discuss is trochanteric pain syndrome and the role the gluteal tendons play in it. This syndrome can cause pain on the outside of the hip, which can spread down to the knee and run into the buttock. Generally these symptoms are aggravated with prolonged walking, going up and down stairs and lying on the involved side. Initially these symptoms where often thought to be associated with inflammation to the bursa on the side of the hip. This was known as trochanteric bursitis. However with improvements in investigations such as MRI and Ultrasound clinicians now believe that the tendons of the gluteus medius and the gluteus minimus muscles are more involved. We believe that the pain that is experienced is a result of these tendons being over loaded and losing their structural integrity resulting in them breaking down. This condition is known as a tendinopathy. How does this happen? This overloading of the tendons on the outside of your hip is often the result of poor control and balance through the pelvic and lower back regions. On assessment there is often a weakness through the muscle groups that are associated with stabilizing the hip joint. A…
Monday, 01 June 2015 20:29
Physiotherapy and Golf
My name is James and I am one of the lead physiotherapists at South Coast Physiotherapy. I would like to welcome you to my first ever blog for which I have decided to write a little about a common complaint which I am regularly treating at the clinic. Living on the Mornington Peninsula we are fortunate to have a plethora of high quality golf courses. Golf is a great past time which offers the perfect low impact exercise which, as physiotherapists, we encourage our patients to partake in. There are, however, injuries associated with playing golf and none more common than low back pain which has been found to make up 25% of all golf related injuries and is certainly an injury we see a lot coming through the doors at the clinic. Interestingly low back pain has not only been shown to be the most prevalent golfers injury but also has been shown to have a significant effect on the efficiency of a players swing with research showing back pain reduces downswing velocity by up to 50%. One of the reasons for the prevalence of these low back injuries is the biomechanics associated with the golf swing. The golf swing involves an asymmetrical rotational velocity with the slow back swing going away from the body and then a fast and powerful downswing in the opposite direction. This creates an imbalance through the lower back (lumbar spine) with one side of the spine being put under more stress than the other. Added to this imbalance is the repetitive nature of the golf swing. Be it with taking numerous practice swings before each shot during a round of golf or with going through a bucket of balls on the driving range, an average golfer is going through a high number of…