Uncategorized

Optimising outcomes after ACL surgery

by

ACL surgery rehab physiotherapy newcastle australia

As discussed in our previous post, the rate of ACL surgery in Australia are on the rise. We are also performing the most ACL reconstructions per person than any other country in the world. Alarmingly though, the incidence of secondary ACL repairs is rising at a greater rate than primary repairs! Why is this so? Part of the reason may be due to the quality of rehabilitation and/or the decision-making process regarding return to sport (RTS).

So, what does a high-quality rehabilitation program comprise of, and what needs to be considered when making a return to sport?

An ACL rehabilitation program should be individualised. The stage of healing, current impairments and the individual’s goals must be considered. A quality program should be broken into phases with the athlete working towards specific goals within each phase before progressing to the next phase. The athlete should be guided by their physiotherapist to restore normal joint range of motion, muscle strength, balance and proprioception (awareness), landing mechanics, speed, power and agility. Then, the athlete must prepare for returning to sport. During this last phase of rehab, it is very important that the athlete attempts progressively harder sport-specific exercise and develops confidence in the tasks they will be required to do in their particular sport. This process should be guided by a physiotherapist who can take specific measurements to determine progression of rehab through the various phases.

Deciding when to return to sport can be difficult. In 2016, a meeting of world experts in injury management developed a consensus statement on returning to sport. One of the key findings from this conference was that the time to RTS varies among individuals, unrelated to the type and severity of injury. While time alone is not a reliable indicator of readiness to return to sport, it has been found that the likelihood of re-injury is reduced by 51% for each month a return to sport is delayed from 6 months until 9 months post-surgery (Grindem 2016).

So while delaying a RTS until at least 9 months following surgery is wise, decisions should be made based on information from a battery of tests. These tests should include not only physical tests such as strength, power and agility, but also assessment of psychological readiness and confidence. One particular study found that individuals who did not successfully complete the outcome measure at the end of their rehabilitation before returning to sport were 4x more likely to re-rupture their ACL (Kyritsis 2016).

If you’ve injured your knee and want help to ensure you optimise your recovery and avoid reinjury, contact us on 02 49216879 or admin@numovesphysiotherapy.com.au.

Please find the articles referred to in this post below:

  1. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture (Kyritsis, 2016)
  2. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern (Griffin, 2016)
  3. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: The Delaware-Oslo ACL cohort study (Grindem, 2016)

ACL reconstruction on the rise in Australia

by

Newcastle football physiotherapy

 

News reports of high-profile athletes being sidelined due to ACL injuries seems to be becoming more and more common in Australia – and a recent study suggests that this isn’t just a coincidence. Research published last year has found the incidence of knee reconstructions performed in Australia to be on the rise, with Australia now performing more of these surgeries than any other country in the world!

From 2000 to 2015, the annual incidence of this surgery increased by 43%, and by a staggering 74% among those under 25 years of age. Those most likely were men aged 20- 24 years, and women aged 15 – 19 years. It is suspected that this is a result of greater participation in these age groups in high risk sports which involve pivoting, jumping and rapid deceleration. It is estimated that 72% of ACL reconstructions in Australia are sport-related, with sports such AFL, rugby, netball, basketball, soccer and skiing the most frequent culprits.

Perhaps even more alarmingly, the percentage of people undergoing revision ACL reconstructions was found to be increasing more rapidly than those undergoing their first reconstruction! This suggests that not enough people are completing high-quality rehabilitation, or perhaps are returning to high-risk activities too soon.

In the following weeks we’ll discuss how to most effectively prevent ACL injuries, and the evidence behind making a safe return to sport after undergoing surgery. If you’ve injured your knee and are considering surgery, or if you’ve already had knee surgery and want to ensure you optimise your recovery and avoid reinjury, contact us on 02 49216879 or admin@numovesphysiotherapy.com.au.

To read more on this topic go to: https://www.mja.com.au/journal/2018/208/8/increasing-rates-anterior-cruciate-ligament-reconstruction-young-australians

Bending the back

by

Back pain physio newcastle australiaWe all know the old posters showing correct lifting technique. An ominous red cross stamped atop a person bending the back to pick up a box. The message was clear “keep the spine straight and move through the hips and knees when lifting”.  After all, many back injuries result from lifting with a rounded spine. However, what if there is no load or you are not lifting? Is it unsafe to tie our shoes, or play with the kids? This message has been misinterpreted somewhat. Fearing bending the back (spinal flexion) when it is not under load in some cases can lead to persisting back pain. The problem is that if we don’t move and stretch our spine, it can become inflexible and tight, possibly leading to further injury. Maintaining flexibility and stability throughout our spine is optimal to allow us to perform everyday tasks and reduce back pain.

If you have recurrent back pain and don’t stretch contact us on 4921 6879 and we can develop a suitable program of movement to reduce pain.

NU Pilates is also a great way to introduce safe spinal flexibility and core stability for those who want general body conditioning for back pain. A physiotherapist supervises our small group classes, so your exercises are modified appropriately to suit your body.

To bend or not to bend – the choice is yours.

Shoulder posture and movement

by

Physiotherapy shoulder newcastle

The shoulder blade is an attachment point which the rotator cuff muscles of the shoulder operate from. Its only bony connection to the body is via the collar bone which in turn connects to the sternum. Otherwise it is incredibly moved and controlled by muscles connecting from the trunk and neck.

The muscles that hold the shoulder blade in position are often affected by pain in the region and what is normally a coordinated movement becomes the opposite. Because it sits over the back where you cant see it you often don’t know its moving poorly but this is sometimes what can lead to persisting shoulder pain. If assistance to correct the movement improves pain then you need to start with scapula rehabilitation.

The very old fashioned advice of shoulders “back and down” is not good advice. In fact the starting posture for a lot of us needs to be more “up, back and hold” but that also depends on your posture. The most common movement dysfunction is when the shoulder drops forwards and down and the shoulder blade wings or lifts away from the body nearest to the spine.

There are good and bad ways to correct posture of the shoulder blade. We use a combination of key verbal instructions, hands on facilitation of position and movement, mirrors for visual feedback, and sometimes tape to assist the process. Static posture holds are the starting point with correcting poor movement of the shoulder blade but it also needs to be progressed to functional movements like reaching overhead to a cupboard in front.

Some people are able to get the shoulder blade posture and movement better quite quickly but others take some time and repeated practice to move better and reduce pain. If you aren’t sure of how to correct your shoulder posture or if you have shoulder pain then we would be happy to help you. If you have shoulder pain a carefully prescribed exercise program can help.

Physiotherapy gym exercise shoulder

Read more about movement control problems in the shoulder (dyskinesia).

Spinal pain treatment – move more often

by

 

Back and neck pain treatment

NU Moves Physio leads the way in evidence based treatment. We are constantly looking to the latest evidence to help our clients move better and feel well. Being located at The University of Newcastle means a lot of our clients are academics, students and staff. A few areas we commonly treat are back and neck pain, which many people attribute to postural or sitting loads at work or while studying.

The scientific understanding of this problem has definitely evolved over the last few decades and has now changed significantly from the old adage of ‘sit up straight and don’t slouch’ to the ‘move more often’ advice. Move more means varying your postures and positions rather than having to sit up straight all the time. It might be that you need slouch a little if you have been upright for a while or sit back in your chair and use your backrest to sit up tall if you have been slouching. Stand desks are great to get you out of your chair but not for standing all day. A mixture of sitting and standing changes your posture which is best.

This is notably advice based on research for lower back pain. A common mistake leading to neck pain is reaching too far whilst at a computer.  Neck pain is often also related to the stress and tension that we carry in our shoulders. Again the best advice is often to get up and move more – go for a walk or do some exercise for 30 mins aiming for a daily basis. If you are too busy to walk that is often the problem that needs to be managed.

Professor Peter O’Sullivan leads the way in back pain research and advises ‘your best posture is your next posture’. Simple spinal pain treatment – move more often!

If you have neck pain or back pain at work or study, get moving and if pain holds you back then contact us on 0249216879 or admin@numovesphysiotherapy.com.au

Stress Fractures In Football

by

Football Physio Newcastle

Stress Fractures In Football

As we move towards selection for next year’s club football sides there is a tendency for players to push harder to prove themselves. More training, higher intensity, less rest / recovery time plus there can be school soccer games added in there, not to mention lunchtime playground fun. One consequence of an imbalance in load versus rest time is stress fractures. The earlier the problem is diagnosed the better the outcome and given that stress fractures can unfortunately lead to prolonged periods of lost game time, it is an important topic in football health and wellbeing. We have previously published a blog regarding stress fractures in runners, which includes a detailed explanation of the cause, biological process, diagnosis and management which you can read about here.

This blog will focus on some common causative factors and the division of the “high risk” versus “low risk” types of stress fractures, as these are managed very differently. The risk relates to the specific location within a given bone rather than the likelihood of developing that type of stress fracture.

Stress fractures almost always occur in one of the following scenarios, or a combination of these.

  1. Increase in load on a region of the body in a given (often too short) time period
  2. Decrease in recovery time relative to loading time
  3. Decrease in the bone’s ability to repair / remodel following exposure to load.

Therefore, when volume of load increases the risk is higher, such as progressing to a higher competitive level of play, a busy period in the season with extra games and training sessions, an increase in training load such as during pre-season fitness training or even a change in training surface or footwear relative to the amount of loading. Conversely if the athlete’s load remains unchanged but they have a change in diet, energy input, illness or nutritional balance this can lead to an increased risk of injury.

High risk stress fractures generally involve a bony area where there is critical blood supply or an ossification centre (where the bone grows from). An example of these are the Femoral neck (hip), Navicular bone (midfoot), base of the 5th metatarsal (outside of foot) and the medial malleolus (inside of the ankle). These are considered high risk due to the possibility of a full fracture disrupting the only blood supply to this part of the bone, which can lead to ongoing problems. The high risk stress fractures are often managed initially with complete unloading / non-weight bearing and then closely monitored during the periods of activity reduction / relative rest including repeated imaging studies to track bony healing. In more severe cases these can require surgical management. High risk stress fractures often require orthopaedic specialist involvement in early management. Regardless of severity if a stress fracture is diagnosed we recommend assessment and advice regarding management with a sports physician specialist.

Low risk stress fractures are located in areas with good blood supply which are known to heal well with relative rest and progressive rehabilitation. These are more common in soccer and mostly found in the postero-medial tibia (lower inside of the shin) and in the metatarsals (the forefoot). This type of stress fracture can usually be diagnosed clinically but usually require imaging (MRI / Xray) to confirm type and severity.

Effective management of these injuries in soccer players requires good communication between the physiotherapist, sports physician, coaches and player, especially given the potentially longer period of recovery than most soft tissue injuries. It is important not to continue to play if a stress fracture is a possibility.

If you have any questions on the information in this blog or need assistance in diagnosis or rehab relating to soccer injuries, contact us on admin@numovesphysiotherapy.com.au or 49216879.

Winter Sports

by

Winter Sports Physiotherapy Newcastle

Going skiing or snowboarding these holidays?

Remember to keep up your strength training before heading off on your trip. This will allow you to ski/board for longer without fatiguing. More importantly, strength training will also reduce your risk of injury. Great ways to improve strength and fitness indoors this winter include yoga, spin classes, weight training, rock climbing and more.

Another great way to improve your strength is through Pilates. Our Pilates classes run on 7am Mondays, 6:30pm Mondays, 7am Wednesdays and 12:15pm Fridays. Pilates helps to improve physical strength, flexibility, posture, and enhance mental awareness. All these benefits will allow you to be stronger and safer on the snow – these equal more fun!

Staying active throughout the winter can sometimes be difficult. No matter how choose to keep active and get stronger, something is better than nothing! Buy yourself some new exercise clothes. Remind yourself of your fitness goals, or make new goals.

For more information on sports preparation.

Football Injury Prevention – Fifa 11+

by

football injury prevention

The football season is stepping into full swing once again, and it is important to know that football injury prevention via sports conditioning is effective. Developed in 2009 and rapidly utilised worldwide, the Fifa 11 + Injury Prevention Program has consistently demonstrated injury reductions of 30-50% when implemented at least twice a week. The Fifa 11 + is designed to improve lower limb and core strength, develop neuromuscular control and body awareness to significantly reduce injury.

The warm up program follows a progressive number of exercises from running, to strengthening and balance that is both individual and partner focused. The program identified the most common mechanisms behind common football injuries, such as rapid changes of directions with insufficient knee control and ACL rupture. Through a 3 part program it aims to address and change the factors that contributed to the injury mechanism – retraining movement patterns, body awareness, core strength and control.

So what does Fifa 11 + involve?

Part 1: Running exercises

Part 2: Strength, Plyometrics, Balance.

Part 3: High level running exercise.

In total, the Fifa 11+ only takes 20 minutes to complete, with minimal equipment and space requirements. It can be completed individually, or as part of a team, with a number of exercises partner focused to challenge proprioception, balance and agility.

The Fifa 11+ program is a tool we advocate for our football players over the age of 12. If you have any questions regarding the program, how you can implement it, or where to begin, feel free to email us. If you are serious about football then your team should be doing the FIFA 11+ before each training. For an individualised football training program, book an appointment with one of our physiotherapist’s.

Watch our Facebook and Instagram over the next month for video and comments on each of the exercises in Part 2 of the FIFA 11+.

Starting off 2018 Pain Free and Positive

by

42345147 - side view of smiling business colleagues looking at each other

With 2018 under way and the upcoming uni semester fast approaching and workloads increasing, it is important to consider how to best maintain our health and bodies at home and at work. Particularly for those of us on campus working long hours at desks, computers and various projects, a large risk is the onset of neck pain. Not only is this uncomfortable, but impacts on our day to day routine and often effectiveness at the tasks so important to us.

As campus gets increasingly busy, it’s more important than ever to keep moving, and keep an eye on our work related postures. Although pain often follows trauma, it is often a consequence of remaining too long in one posture, whether this is sitting or standing. This may be seated at the computer desk, looking at our phones, or standing and chatting to colleagues. Chances of injury or pain is then increased with any kind of stress that may be experienced throughout the day.

As a university physiotherapy clinic that has been on campus for 14 years, NU Moves understands the workplace demands on staff, including the regular postural demands and time constraints. We are also familiar with treating a range of resulting issues such as neck, arm and lower back pain. Manual therapy or exercise prescription are extremely useful tools that our qualified physiotherapists can use to get you on track to moving well and feeling great. A great goal to aim for in terms of movement is 30 minutes a day, and 150 minutes a week, whether this is walking to lunch, your car, or to grab a coffee.

If you are experiencing pain at work, or wanting to maximise your health and movement, NU Moves Physio can help. With post graduate qualifications and experience in musculoskeletal assessment, manual therapy, exercise prescription and outstanding problem solving, out physiotherapists are here to help. One on one treatment sessions involve a thorough assessment to determine what is causing your pain, and a treatment plan explained in depth, so you know how to approach improving your health from your first appointment.

Managing an acute injury – the first 48 hours

by

acute injury

Uh-oh I’ve pulled a muscle, what do I do? Firstly, please, don’t stretch an acute injury. This is likely to further tear a muscle and cause more bleeding.

Its winter sport pre-season training time again! Which means I’m about to see a bunch of active, healthy 20-40 somethings (and some really enthusiastic 50 somethings) with an acute muscle strain. I frequently see people 24-48 hours after the injury has happened. These go getters and weekend warriors have often done all the usual injury management recommendations, which is now P.O.L.I.C.E. by the way.

POLICE:

Protection – don’t keep playing through an injury. This will make your recovery period much longer, and cause more pain once you cool down.

Optimal Loading – Initially, minimal loading is ideal, then gradual increases in load. However amount and type of loading depends on the injury. So best get it checked out.

Ice – Analgesic (helps with pain), widely used. There is no research published on effectively reducing recovery time with ice.

Compression – Bandages, tubigrip, compression socks, skins! Etc. This helps to control swelling and slows inflammatory fluids leaking into all the surrounding tissue. This will then slow the recovery and increase periods of immobility.

Elevation – put your injured part, above your heart. Vessels that remove swelling work best with gravity assistance – so place them up high, you can’t fight gravity.

Once you have the initial management under control, it is important to get the injury assessed by a qualified physiotherapist. This is because the management program and time to return to play varies dramatically by injury site, mechanism, severity and sporting demands. This injury may require a completely different strategy to your last muscle strain or your teammates, even if it is the same muscle.

Unfortunately, poorly managed muscle injuries have the possibility of becoming a persistent problem. We will often see athletes with an old muscle injury that has reached the chronic injury stage. This then requires a long term targeted rehabilitation intervention. These are usually successfully rehabilitated but can take some time to improve, and can be frustrating for the keen athlete wanting to play at 100%.

The role of medication is a frequent question asked in the clinic. Non-steroidal anti inflammatory drugs (NSAIDs) such as ibuprofen or diclofenac are frequently used. It is a complex topic, but the take home message is that there may be a small improvement in recovery time. Allowing 48 hours before taking anti-inflammatories is ideal to reduce bleeding within the affected muscle. Unfortunately, these medications carry some potentially serious adverse effects, which can cause damage to the stomach, kidneys and cardiovascular system.

In conclusion, use the P.O.L.I.C.E. principles, get an assessment, get a plan and give your body the best chance to make a full recovery prior to returning to sport. If you are unsure about any of the above, please contact us on 4921 6879 or email admin@numovesphysiotherapy.com.au